by Rhonda Mullen n today's complicated and interrelated world, public health issues exist not in isolation but rather often are entangled with those of primary medical care, of legislation, of government, and business. With t he advent of managed care, today's practitioners need to be focused on preventing as well as curing disease. In drafting laws that affect health care, legislators need not only the skill to write legislation but also understanding of the public health imp lications of their effort. To develop effective nursing strategies in developing countries or in the United States, nurses often need the skills of epidemiologists and health educators. Joint-degree students at the Rollins School of Public health are preparing to meet these challenges by combining studies in two disciplines. A medical student believes she'll be a better doctor because of her training in public health. A nurse practiti oner now has the public health skills to set up a mental health program in africa. A business student is tackling health care technology in Chile. And a law student wants to use the law as a vehicle for delivering social justice.

hursday nights find Marisa Rogers eating dinner with the homeless men and women at the Open Door, a community that works to fight homelessness in Atlanta. With her busy schedule as a dual-degree student in m edicine and public health, Rogers says that it's the one decent meal she can count on each week. As the supper dishes are cleared, Rogers goes to work in an on-site clinic, where she volunteers her time as clinic manager. She recruits and schedules volunteer physicians to staff the weekly clinic. She also has recruited first-year medical students to take patient histories and vital signs. And she has actively solicited prescription and over-the-counter drug donations from pharmaceutical companies for clinic use. The clinic staff sees patients with a range of medical complaints, including musculo-skeletal problems, hypertension, diabetes, pain, addiction, and mental illness, according to Rogers. The staff refers serious or emergent cases to either Grady Memoria l Hospital or one of its satellites, where the homeless patients may be seen by one of the same doctors who volunteer at the clinic. In her experiences at the Open Door, Rogers says her training in medicine and public health has come together. She has now finished the third year of medical school as well as the year of classes required for the MPH. "My learning curve has shot up," s he says. "I'm integrating my primary care skills with some of the larger issues of preventive health and health policy." Rogers believes her public health courses have taught her "a very different way of thinking. They are more abstract than my first two years of medical training, which tended to be didactic and memorization-based." She believes her background in public health and the experiences at the Open Door clinic will make her a better physician. "Medicine isn't practiced in a vacuum," Rogers says. "There are so many issues doctors now need to be aware of, such as the healt h care environment we'll be practicing in. It is so important to understand the political and economic climate. Listening to the stories of the homeless and getting to know many of them personally has strengthened my resolve to work towards a day when ade quate health care for all is a reality in this country." Recognizing outstanding voluntary service, Rogers this year received the Gaston Service Scholarship from the medical school. It is only one of the accolades she has received. She is one of only eight recipients of the 1998 Arthur Ashe Program in AIDS C are Fellowship. She is a Dean's Scholar at the School of Medicine, listed among Who's Who among Students in American Colleges and Universities, and a former Robert W. Woodruff Scholar in Emory College. Rogers's record is not unusual for the highly motivated and talented students who seek joint degrees in medicine and public health. A large percentage of Rogers's predecessors also have been Woodruff Scholars. They have tackled the eradication of Guine a worm in Nigeria, the prevention of neonatal tetanus in Nepal, malaria prevention in Kenya, iodine deficiency in Haiti, and other global health projects. One recent MD/MPH student helped found a successful student-run Health Outreach Program at Emory, wh ich involves more than 100 medical students in volunteer outreach health promotion projects for underserved Atlanta populations. As Rogers began her busy fourth year of medical school this fall, she was continuing to volunteer as clinic manager at the Open Door Community. She'll recruit another manager to take her place after graduation in May. She also hopes to obtain donations for basic medical equipment, such as a scale and a machine to measure blood glucose. "So far," Rogers says, "this is the most worthwhile contribution I've made in my life."

A joint-degree student in medicine and public health, Marisa Rogers believes her experiences as a volunteer clinic manager at the Open Door Community will make her a better physician and public health practitioner.

hen Sue St. Clair went to Liberia in 1981, she found the people in the villages where she worked as a nursing educator to be primarily concerned with survival. "I tried to help them find more progressive and healthy ways to survive so they could move toward appreciation for some of the higher levels of the human condition," St. Clair says. "They told me, 'You've come to enlighten us.'" For the next seven years, St. Clair went about that enlightening, simultaneously learning herself from the Liberian people. "They have such a vital force about them," she says. "They taught me about the strength of the human spirit, joy in little thing s, and a deeper understanding of unity in community life. I realized this was my mission in life. This was my opportunity to put my faith into action." After St. Clair returned to the United States, she began to think about pursuing additional training to become better prepared for her chosen work. The MN/MPH degree at Emory was a good fit for her interests, allowing her to gain skills as a family nur se practitioner and psychiatric/mental health specialist while expanding her knowledge of international health and health education issues. This spring, she not only finished her joint degree but also won the Eugene J. Gangarosa Award at the Rollins Schoo l of Public Health. The award is presented to the graduating student who has demonstrated a creative approach to solving public health problems and who shows promise for outstanding service in the international arena. The public health problem St. Clair tackled was mental health in Malawi. For her thesis, she had wanted to work on a project in the villages of Africa, but it was an accident that she arrived at the issue of mental health, she says. At a conference on mental health, St. Clair met an earlier MN/MPH graduate, Jody McGill, who is now a Christian missionary in Malawi. McGill invited St. Clair to the Embangweni Hospital medical mission in northern Malawi, offering to be her nurse practitioner preceptor. McG ill also suggested that St. Clair might want to use her mental health skills by assisting the Malawian psychiatric nurse at the hospital. A seed was planted. St. Clair discussed her idea with Ron Mataya, a fellow student and Humphrey fellow. He knew of no community-based mental health efforts in his home country, Malawi. As she continued to investigate, St. Clair found that "worldwide, mental health is not being addressed, especially in developing nations." With a Graduate Innovative Award from the School of Nursing, St. Clair set off to Malawi for three months to see what she could learn about this need and how she could start to fill it. St. Clair made the missionary hospital in the northern district her base. From there, she could reach mobile health clinics in 14 nearby village centers served by the mobile health clinics of the hospital. She focused on three of these village centers (approximately 20 villages) to consult with village leaders, including the traditional healers, about their interest in pursuing a mental health program in their area and if they would participate in its development. Learning the more important greetings in the local language, Timbuku, St. Clair then worked with a translator to develop a knowledge, attitudes, and practices (KAP) survey. She surveyed people from the three village centers as well as mid-level health workers at three of the hospital's outlying health clinics. Based on the data collected, she helped coordinate a two-fold training program - one for village health workers and one for the midlevel clinic workers. The training's goal is to promote mental health education, to help the workers identify patients wi th mental health problems, to familiarize them with medications and appropriate use, and to help them recognize when they need to refer patients to the next level of care. St. Clair also recruited a mission psychiatrist some two hours away to serve as the expert referral for the region. How did she accomplish so much in three months? "In addition to a deep sense of mission and purpose, there were no distractions," she says. "There was nothing to do but work."

Sue St. Clair, a joint-degree graduate of nursing and public health, tackled mental health in Malawi for her thesis, work on which she continues to build.

his summer marked a defining moment for Alan Roemer. A joint degree candidate in the Rollins School of Public Health and the Goizueta School of Business, Roemer arranged an internship with a private hospital in Santiago, Chile, bringing together his interests in business, health care, technology, and Latin America. At Clinica Indisa, Roemer worked directly with the president/owner of the hospital and the management team. His specific role was to help standardize aspects of care and control the utilization of resources, all the while ensuring a quality of care sta ndard. "The system in Chile is very different from that in the United States," says Roemer. "For starters, all employed persons are entitled access to the public health system through mandatory payroll contributions. Those with more money, however, often choo se the private system, which covers about 25% of the population. Chile's health care market is currently in an evolutionary stage, where privatization is causing an increase in competition. So costs are coming into focus." Roemer traces his interest in health care back to his undergraduate days, when he worked his way through school as an emergency medical technician. "After riding ambulances through college, I considered medical school," Roemer says, "but I needed to sp end some time away from school to decide what I wanted to study." He took a job as project analyst in the management associate program at NationsBank but missed the health care industry. He next worked in the health care practice area of Booz-Allen & Hamilton, Inc., moving later to the health care information technol ogy practice at Deloitte & Touche, a consulting and accounting firm. With five years of consulting experience, Roemer decided to return to school. "I was drawn to Emory's programs because of the rising reputation of the business school, combined with one of the nation's top public health programs, and an international f ocus," he says. During his first year at the business school, Roemer began to spread his interest in public health to his business classmates by founding the Goizueta Business School Healthcare Club. At informal breakfasts, the club, which now has more th an 20 members, allows students an opportunity to form networks with each other as well as alumni and professionals in the health care field. In advising other students interested in a joint degree training program, Roemer believes that having predefined goals is important to success. Roemer's own goal is to be a leader of a health care organization in Latin America. He also has entrepreneur ial interests in brokering American medical technology to emerging markets in Latin America. "Technology is integral to the delivery of health care today," Roemer says. "It is no longer just a financial or billing tool but rather a clinical tool to monitor a patient's progress throughout the process. As hospitals, physicians, and insurance com panies become more and more integrated, the importance of communication and coordination of technology grows exponentially."

Alan Roemer, who combines studies in business and public health, spent the summer in Chile, learning the intricacies of its health care system.

or Andrew Fishman, "public health is about social justice. For me, the law is the vehicle for furthering that." However, because Fishman feels that law school by itself inadequately emphasizes advocacy, he is pursuing an MPH in addition to his JD. The first joint-degree student in the schools of law and public health at Emory, Fishman is leading the way for others interested in training in the two disciplines. He will serve as president of the Emory Public Interest Committee, which promotes inte rnships and careers in public interest and advocacy arenas. "I want to build the notion that the law isn't just about landing a job at a large firm but can also be used for the public good," Fishman says. This past year, he also chaired the Inspiration Awards at the law school, helping raise $20,000 at a gala benefit where three leaders in the public interest sector of law spoke. The money will support student internships in law that benefit the public. Fishman will continue to build on his quest for social justice by completing an internship this coming year with the Southern Center for Human Rights. The organization advocates for prisoner's rights, particularly those on death row. Fishman is particu larly interested in legislation governing capital punishment cases. "I'm concerned about the role of mental illness in capital cases and the justice of executing people who may have only marginal intelligence and sanity," he says. This past summer, Fishman completed an internship in the American Schools of Public Health summer interns program. He spent 12 weeks working for the Centers for Disease Control and Prevention's Office on Smoking and Health, researching the legal issues surrounding nine state settlements now in progress with the tobacco industry. Specifically, he studied the constitutionality of the bans on outdoor advertising of cigarettes and documented the session laws surrounding the enactment of smoking prohibition s. Previously, he worked for the American Cancer Society on the prevention of tobacco-related illnesses. Fishman believes that more and more students will begin to pursue careers that span public health and the law. "Some of the most compelling work today, for example, universal health care, will require expertise in both," Fishman says. For this student, "it's not enough to just have a cause. Most significant social movements have occurred with the backing of the courts and the law," he says. "If you have sound legal backing, that's where your strength comes from."

The first joint-degree student to enroll in law and public health at Emory, Andrew Fishman is leading the way for others interested in similar training.