By Susan Gallagher
Studying abroad in Scotland as an undergraduate at Iowa State University, Joshua Rivenbark developed a yearning to see more of the world, and it wasn’t long before he was scheming about how to incorporate international work into his career. His next trip abroad—a month-long service learning experience in Rwanda, where he spent time with children and adolescents in schools and residential care settings around the country—sparked his desire to improve life chances for the most disadvantaged people. That’s when he began to see the possibility of merging his aspiration to become a doctor with his passions for travel and working with vulnerable populations.
Fast forward 10 years, and as a global health doctoral scholar at Duke, Rivenbark has been working with a different group of orphans in Cambodia as part of a multi-country longitudinal study of orphaned and separated children. Through the doctoral scholars program, Duke PhD candidates from various disciplines conduct in-depth research on a topic that straddles their primary discipline and global health.
As an MD/PhD student at Duke, Rivenbark has carved his own academic path. He’s the first student to pursue a dual doctoral degree in medicine and public policy and the first medical student to participate in the Duke Global Health Institute’s doctoral scholars program. We talked with him recently to learn more about his unchartered path, the connections he sees between medicine, public policy and global health, and his most memorable takeaways from the field.
DGHI: Why did you pursue medicine, public policy and global health at Duke, and how do you hope to incorporate these fields into your career?
Rivenbark: I’ve known for a long time that I want to be a doctor and take care of patients. Before I came to Duke, I was working in immunology research and applying to medical school, which is a typical path for biochemistry majors like me. Through that work, I realized that I didn’t want to pursue “bench science,” but I really liked research overall. I was more interested in public health and health disparities around the world, so I decided to pursue a social science PhD that would allow me to do global health and international work.
Duke was one of the most flexible programs and has a large global health institute that integrates well with the medical school and the university. And the policy school, with its interdisciplinary approach, helped tie the two together. As soon as I learned about the doctoral scholars program, which enables PhD students in other disciplines to conduct global health research, I knew that’s what I wanted to do.
After I finish my PhD this spring and complete my final year of medical school, I plan to do a residency in internal medicine and continue doing global health and population health research. And from there, I’ll look for research fellowships and faculty positions within medical schools that have a large global health presence. Ultimately, I hope to end up in an academic center where I can practice medicine and do global health research.
DGHI: How do you think your training and experience in these three fields complement each other?
Rivenbark: The information I’ve learned in each field helps with the others. One benefit of the clinical training that I’ve received so far is that it has given me insight into the on-the-ground processes that are involved in causing health problems and also in treating those health problems. Sometimes you don’t get that when you look at big picture research studies or population data. And that in-person insight has been helpful while I’ve been in graduate school.
And I haven’t returned to medical training from the research side yet, but I think I’ll go back with a much broader view of what’s going on that might lead to some of the issues that my patients are having—like bigger structural problems and societal issues that contribute to disparities in health outcomes. I’m better able to think about health on a population level, which is not always on your mind when you’re seeing one patient right in front of you.
And these disciplines require very different ways of thinking, so going between them is just a helpful mental exercise.
DGHI: What’s your most memorable experience from your field research in Cambodia?
Rivenbark: For my doctoral scholar research project, I worked with Dr. Kate Whetten, a public policy and global health professor, to look at how perceptions of stigma and discrimination towards orphaned children in Cambodia, as well as perceptions of social status, relate to healthcare decisions these orphans make as they become adults.
There was one moment that has stuck with me for quite a while. One of the questions I included on my survey is a question that people who study social status and perceived social status often ask. It’s a picture of a ladder, and you tell people, “This ladder represents the society you live in. The highest rung represents the richest people, and the bottom rung represents the poorest.” Then you ask them, “Where do you think you are on this ladder?” It’s a question that’s commonly used in research, and I hadn’t given much thought to it.
But a lot of the people from the study are from really disadvantaged backgrounds and have had a tough life, and when they were asked this question, many of them became very sad and distressed thinking about it. The first time I saw someone break down and cry when they were asked this question, it really hit home to me just how much a person’s ranking in society matters to their identity, and that this is true across contexts. It’s something people talk about a lot in the U.S., and it was very clear that it matters to people in Cambodia as well. Feeling like you’re at the bottom of the ladder and everyone else is ahead of you is a really difficult place to be.
That experience made me appreciate even more the fact that people are taking time to participate in our survey when the questions are not always comfortable things to talk about. In terms of the question itself, I was already interested in how people perceive their own mobility, but following up on this question with people after the interviews, I got to think about that even more—how far people who think they’re at the bottom right now think they can move up. And that’s not the same across people and across situations. I want to continue exploring this idea: who thinks they can improve their situation and whether they can or not.
And in addition to that experience, the partnerships I’ve developed with colleagues in Cambodia and everyone I worked with there have been really meaningful to me. Getting to know local researchers, getting insights from them into the place where I’m working, and having their support and friendship has really been a highlight of my time at Duke.
I’m better able to think about health on a population level, which is not always on your mind when you’re seeing one patient right in front of you.Joshua Rivenbark, global health doctoral scholar