In the continuing move to reform the nation’s healthcare under the 2010 Affordable Care Act, Preventative Medicine, with its potential to reduce costs while saving lives, has been at the forefront. Eden Wells, 50, Associate Director of Preventative Medicine Training at the University of Michigan, is a leader in the push towards more preventive care, and is responsible for training many of those who will be serving the community for years to come.
Wells defines Preventative Medicine as a discipline that looks to engage in “proactive, rather than reactive medical care” And feels that “it is a part of any good Primary Care practice.” Since 2011 when she earned the position, her program has focused on hands on, community oriented training for residents. Each resident spends 15 months of the two year program out of the classroom, in a mix of State a local level Public Health centers, and Primary Care settings.
Wells originally trained as an internist, gaining her medical degree for The Ohio State University in 1989. She finished her residency in 1992 with Vanderbilt University Hospital, with her specialization in internal medicine. It was at this point that she began to look off the beaten track. “I was looking at possible careers as an internist and I realized that I didn’t see myself practicing in a suburban medical practice” she says “I found that my interests were being pulled to much more rural, underserved areas.”
She had the opportunity to pursue those interests in the form of a call from a recruiter for the Indian Health Services. “I flew on a rickety plane from Billings, Montana… landed in a field, a one lane airport.” She was immediately captivated by the clear blue of the sky over the Fort Peck Indian Reservation. The interview itself took place on horseback. “I hadn’t even gotten off the horse yet, and I knew I’d be there.” The job was not without its challenges, though. The rural nature of the reservation meant practicing without access to many of the resources and techniques that much of modern medicine is built on.
Moving from an academic setting to a rural environment without access to many of the resources and techniques that much of modern medicine is built on “really was an eye opening experience, you learn very quickly that were you train and practice is not how a lot of people live.” It was in this time partially due to the less than optimal conditions in which she was serving, that Wells began to fully appreciate the value of prevention.
There are certain issues one expects to see in a reservation “There were problems of alcoholism, of drug abuse.” These were problems that “We kept seeing again and again, not matter how many programs we had in place.” Wells began to look for the causes elsewhere. She found that it was never one risk factor that could be pinned down and eliminated. “[There were] issues of unemployment, stress from unemployment, mental health issues, substance use issues, and then chronic illnesses that result from a lot of these stressors, you can’t really tease apart all of those risk factors.”
It was a trap, where one community level risk factor would lead to risk in another area. One couldn’t for instance treat the high instance of diabetes in Fort Peck, because “poverty makes it harder to get fresh food” an issue that in turn increases risk of chronic infection. The question then becomes “Where can you break that cycle?”
To answer that, in 2002 after ten years in IHS Wells returned to academia, this time to the University of Michigan. There she earned a Masters in Public Health in 2003. She hoped to gain the perspective necessary to treat the community as a whole, and return to Fort Peck. Instead she remained in Michigan, where in 2006, 2008 and 2009 she received employee excellence awards from Michigan’s Community Health Department, working mostly with influenza. Now, back with the University of Michigan, she trains doctors who she hopes will “graduate and have the skill of both a public health practitioner and a primary care provider, with both those skill sets they can really work at individual and population level care at the same time” by providing education, vaccination, and other preventive tools to their patients.