From the Caribbean to the SF Bay Area — The Search for a Whole-Person Approach

MCL Backstory

By Sharifa Brooks-Smith-Lowe

In early 2024, my mentor, MCL PI Alissa B Sideman, led the interviews of our research project, “Family physicians’ perspectives on important outcomes and policies when caring for people with dementia.” The research included 20 semi-structured interviews and a demographic survey with family physicians (FPs) to explore their views on important goals, priorities, valued outcomes in dementia care, and strategies to overcome barriers. The participating FPs represented a variety of practice environments, including primary care clinics, hospitals, and long-term care facilities.

What struck me most from these interviews was the physicians’ passion for their role as primary care practitioners and their commitment to their discipline. They saw their role as more than medical doctors and took great pride in the core values of family medicine. The term "holistic" frequently surfaced in interviews, reflecting their comprehensive approach to patient care. In recounting their encounters with patients, the FPs were genuinely trying to implement a holistic model of care despite the challenges posed by the healthcare system. 

“Instead of ‘specialists’—even though family medicine is a specialty—we call ourselves ‘comprehensivists,’ because that's really what our specialty is: making sure that the whole human is doing okay, recognizing that he or she has all of those little things that are happening within their humanness.” – FP 12

These interviews prompted me to reflect on how holistic models beyond healthcare are also stifled within larger systemic failures. Specifically, I was reminded of my thesis project, “Exploring the becoming of young mothers in Grenada through understandings of adolescence, pregnancy, and motherhood,” as I found parallels in my analysis then and the insights shared by the FPs.

Grenada is my home country, and my thesis research focused on how adolescent pregnancy there shapes the experiences of young mothers, particularly their journey into motherhood. I explored how these young women navigate societal expectations, religious influences, and limited access to reproductive health services. Additionally, I examined how societal views impacted their identities and the strategies they employed to challenge or adapt to these perceptions. I wanted to highlight the importance of their narratives, which are often overlooked in Grenada's existing discourse on adolescent pregnancy.

My interest in this topic was sparked by a public debate in 2020 surrounding the reintegration of pregnant school-aged girls into mainstream schools. The Grenadian minister of social development, housing, and community development addressed parliament, advocating for policies to support these girls' return to school. Despite no formal policy preventing their attendance, many pregnant girls are dismissed or drop out due to stigma. The public reaction to the minister's comments, alongside the broader conversation about the stigma and discrimination faced by pregnant adolescents, compelled me to delve deeper into the subject and question the true nature of the problem.

I conducted my ethnography at the Programme for Adolescent Mothers (PAM), a school dedicated to providing secondary school education for young mothers who had been dismissed or were unable to complete their schooling due to pregnancy. My experience at PAM fundamentally changed my perspective. Initially, I anticipated that my argument would center on the idea that these girls are no different from anyone else and should be allowed to continue their education alongside their peers. While that belief remains, my time at PAM revealed deeper insights and highlighted an educational approach that, I argue, should be adopted throughout Grenada.

PAM embodied the comprehensivistmindset in its educational philosophy. I engaged with the teachers and staff, attended classes with the students, met their children in the onsite daycare, and shared moments in the kitchen while they recounted lively stories with the chef, which gave me a unique perspective. I observed them speaking candidly about their bodies, their lives, and their experiences with their teachers. I joined them on trips to group therapy and leadership sessions led by one of Grenada’s most renowned psychologists, which was eye-opening. Having grown up in conventional schools in Grenada, I saw that PAM's approach was fundamentally different. The staff viewed these young women as whole individuals, a perspective that traditional schools often strip away, which is shaped by centuries of oppressive colonial ideologies embedded within our systems, institutions, and ourselves.

PAM specialized in what the FPs we interviewed described as the essence of family medicine: “making sure that the whole human is doing okay.” PAM’s approach addressed needs beyond education—much like the approach many FPs we spoke to advocate for, focusing on patients’ overall well-being beyond clinical care. The young women at PAM had access to transportation to the main bus terminal, freshly cooked lunches, onsite daycare for their children, and mental health resources. PAM’s teachers approached topics like sex and infant health with an openness rarely found in conventional schools. The young mothers moved confidently across their serene campus, free from fear of reprimand for how their bodies felt or moved on any given day. Surrounded by teachers they respected—and who respected them in return—they thrived in a space where mutual respect flourished. PAM embraced the ambiguous transition from adolescence to adulthood in ways that defied societal norms. While the outside world often stigmatized these young women for ‘skipping chapters’ too soon, PAM welcomed and supported them fully.

Imagine a world where educational systems value each person’s unique life circumstances, adapt to the diverse needs of every student, and empower them. Envision healthcare that is accessible and affordable and offers individuals the tools and resources—like nutritious food, green spaces, and preventative care—to live healthier lives, thereby potentially lightening the burden on primary care clinicians. As the FPs expressed, many healthcare practitioners want the time, resources, and support to care for each person holistically, moving beyond a fee-for-service model that prioritizes patient well-being over profit and elevates comprehensive, patient-centered care as the standard. In such a world, educational and healthcare systems would no longer reinforce barriers to our well-being but would actively work to dismantle them, cultivating environments that nurture, rather than control, the potential in each of us.