It was late 2020, deep in the throes of the COVID-19 pandemic, when the urgency of Alyssa Botelho's research on the history of rural health care in the United States became clear to her.
- By CATHERINE CARUSO
Botelho had temporarily moved to Great Falls, Montana, with her husband, who was clerking for a federal judge. There, she was writing her PhD dissertation just as COVID-19 began to infiltrate rural communities that had not yet been hit hard by the virus.
As she sat at her computer, poring over historical documents on rural health care systems, "I could hear helicopters overhead day and night as people were airlifted from all over the state to the hospital in Great Falls," she recalled. "It was an intense and immersive experience of witnessing a rural health care system under duress."
The experience only solidified Botelho's commitment to studying the history of medicine. Now, as a newly minted physician and social scientist, she plans to use what she's learned to educate policymakers, physicians, and the general public, while also providing the best care possible to her patients.
"I think my skill set is finding and sharing stories that make tangible the big structural and hidden forces that affect people's experiences in our health care system," Botelho said. "I hope that those narratives can be used to help make medicine a more equitable practice."
Pursuing passions
A child of classical musicians, Botelho was always encouraged to pursue her passions - and it was her dual passions of dance and medicine that initially sent her to Harvard University for her undergraduate degree.
At Harvard, Botelho began to uncover more interests. She wrote for the school newspaper, first ballet reviews, and later, science stories. She interned as a science journalist for several newspapers and at a magazine. She took classes on medical anthropology and the history of medicine.
One of those classes led Botelho into research on the history of science - quite literally.
During a scavenger hunt assignment in the Harvard archives, she stumbled across something intriguing: A folder labeled "Science for the People," with documents about an activist organization of scientists and health care workers started in the 1970s. The group was then active in anti-war and environmentalist efforts, and was also vocal about racism and sexism in science. Later, the Boston chapter worked to create guidelines around early genetic engineering efforts.
Botelho began studying the organization and interviewing local scientists who had been involved in the early days. Eventually, she and two other historians created a collection of the organization's best written works from the '70s and '80s, along with historical commentary.
"It opened my eyes to this community of scientists and physicians who understood that their work was deeply political and not separate from society, and wanted to channel it for the political and cultural good," Botelho said. "I think their history offers lessons to current health care workers who want to critically engage in political and social issues with their work."
As Botelho's pursuits expanded, she revisited her plan to study molecular biology and become a doctor. Instead, she chose to double major in biology and the history of science.
"I've always been naturally curious about people, and how their social worlds affect their life chances," Botelho said. "I began thinking about how I could combine my curiosity about people and my interest in storytelling with my wish to take care of patients."
David Jones, the A. Bernard Ackerman Professor of the Culture of Medicine in the Blavatnik Institute at HMS and a professor of epidemiology at the Harvard T.H. Chan School of Public Health, offered her a roadmap.
Through Jones, Botelho learned about a robust community of doctors who are also social scientists studying fields such as anthropology, economics, epidemiology, and history, including the late Paul Farmer, Jim Kim, Arthur Kleinman, Scott Podolsky, Anne Becker, and others at Harvard and HMS.
"These people are caring for patients but also thinking about the big social structures that affect their patients' health and the way we practice medicine," she said. "I had an 'aha' moment that this was a great path for me to bring my interests together and serve the medical profession."
Lessons from history
With that realization, Botelho entered the MD-PhD program at Harvard, pursuing dual degrees in medicine and history of science.
"As an MD-PhD, you're both acculturated in medicine and an observer or studier of it, so you have to be able to toggle between those roles. I think being able to do both benefits me in both spaces," she said.
Her research has taught her to think deeply about the reasons why patients seek treatment, and what other challenges they may be facing. Her work with patients has informed the questions and issues she chooses to study.
"Seeing patients from different backgrounds and life experiences has helped hit home the idea that people don't come into the clinic from the same starting point," she said. "You have to be able to think and act upon the forces beyond the hospital or doctor's office."
It was the 2016 presidential election, however, that propelled Botelho to study rural health care systems. Following that election, rural America was placed under a magnifying glass because of its role in electing Donald Trump, she said, just as the U.S. opioid epidemic was devastating rural communities, and many rural hospitals unable to stay afloat financially were closing.
Botelho felt that the news coverage on rural hospital closures lacked nuance, and studying the history of rural health care systems was a way she could illuminate the discussion.
"I wanted to bring a social justice lens to the history of health infrastructure in rural areas," Botelho explained.
In particular, she wanted to tell the stories of rural communities and hospitals not often portrayed in the media, including Black and Native American communities. She said she also wanted to explore how white supremacist politics had impeded the development of rural health care systems.
To do this, Botelho sifted through mountains of historical documents, and spent countless hours on the ground in rural hospitals talking to health care providers and patients. She then wrote a series of in-depth historical case studies on rural health care systems throughout the United States.
