Riva Letchinger

 
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I decided to be a doctor in the middle of the Panamanian jungle, as thousands of ticks crawled up my legs. Ticks are born in a large, writhing ball called a “tick bomb” that explodes onto the first warm-blooded creature unlucky enough to step on it. In this case, that was me. 

Before coming to Columbia, this was a daily hazard: I was an entomologist at the Smithsonian Tropical Research Institute, investigating how climate change affects ticks as disease vectors. Between college and jobs, I spent six years working in entomological research. I conducted research on butterflies, ticks, and bees. I loved studying bugs and ecology — I was fascinated by the essential role that such tiny organisms can play in a vast ecosystem. But my work in Panama brought me close not only to the vectors of disease, but also to those suffering from insect-borne illnesses. I lived in a jungle town (Gamboa) that faced daily the effects of insect-borne diseases. Central America was in the midst of a full-blown Zika epidemic. My interest in medicine grew as I tended to friends sick with Chikungunya, Zika, and Dengue; it grew when I contracted E.coli HUS and was exposed to rabies; it grew when I saw the first cases of a tick-borne red meat allergy that has now spread north into the US. I felt powerless. I was researching the origins of infectious diseases but could do little to address how they hurt people. Instead of fighting tick bombs, I wanted to face, head on, the treatment of these tropical ailments. 


I am excited to go to medical school because I want to care directly for people suffering from the kinds of ailments I studied, especially people lacking adequate treatment. Too often, the communities most at risk for infectious diseases, whether Chagas in Panama or tuberculosis in New York, are those that are underserved by the healthcare system. As a physician, it is my intention to help rectify that disparity. As a research coordinator in Columbia’s Neuro ICU, my patients teach me again and again that medicine is far more than fixing symptoms — it means taking into consideration the importance of a person’s life history. While studying entomology, I learned about food webs and to see each organism as the product of multitudinous forces around it. I adopt those same ecological principles to a more humanist paradigm and see daily the importance of incorporating a comprehensive understanding of patients’ social determinants of health into their care.

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Medicine requires the physician to a view a patient in the context of their entire life, not in the isolation of their illness. Like every good ecologist, I view individuals as a part of their ecosystem. We are products of a multitude of interconnected forces (environmental, economic, genetic, and entirely random): “No man is an island entire of itself.” Diagnosis and treatment of an infectious disease demands this type of holistic, expansive approach. It is not just a fascination with disease that motivates me to be a physician: it is a love of working with and for people to figure out these forces.

My motivation to be a physician is rooted in my love of scientific inquiry and driven by my passion for working with people.  I will never lose my fascination with bugs, but only medicine combines the thrill of science with the joy of making a difference in someone’s life. Becoming a doctor is like trekking through a jungle. There may be fewer ticks, but it is just as intense and demanding. I cannot wait.