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Mehret Mandefro, M.D., Ms.C., A.B.

RWJF Health & Society Scholar 2007-2009

Foundation Scholar's Film Encourages Physicians to Consider Patients' Mental Health

 One man's story illustrates how trauma can become a risk factor for HIV.

Throughout his life, David Jenkins seemed to embody the modern gay rights movement. 

He was there when it was born, enjoying a drink at Manhattan’s storied Stonewall Inn on the night four decades ago when police officers stormed the hotel’s gay bar and ignited riots that sparked the gay community’s ongoing battle for equal rights. 

He was there as the movement entered its adolescence in the 1980s, when he became one of the first people in the country to be diagnosed with HIV/AIDS. 
And he has looked on as the movement has matured into a global crusade for civil rights.
But there is more to Jenkins’ life story than his journey as a gay man through the late 20th century. His is also a story of redemption, says Mehret Mandefro, M.D., M.Sc., A.B, a physician-cum-advocate-cum-filmmaker who is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2007-2009) and a newly selected White House fellow. 
Mandefro, 32, explores Jenkins’ early experiences with violence, his battles with disease and poor mental health, and his salvation in “David the Piano Player,” a film she produced about Jenkins’ life while an RWJF Scholar at the University of Pennsylvania. The film is set to release on or around World Aids Day, December 1; an accompanying book is also in development. 
In a story told in reverse chronological order, the film begins with Jenkins’ recent death and documents his decades-long battle with HIV/AIDS, a struggle punctuated at times by alcoholism and depression. The story culminates with Jenkins’ experiences healing from domestic violence as a young man and long-term sexual abuse as a young boy. 
The backwards narrative enables Mandefro to highlight the connection between Jenkins’ formative experiences with abuse, his subsequent decisions to engage in risky behavior, and his ultimate acceptance of his fate. It is a story about death and disease, but also about triumph over adversity. 
“Instead of witnessing pain, we’re actually witnessing salvation and strength,” Mandefro says of Jenkins, who benefited later in life from supportive therapeutic relationships and was able to die in peace. “He is the poster-boy for recovery with a lot to teach about resilience.” 
Film Explores Link between Trauma and Health
Mandefro hopes the film will help people—and health care providers in particular—understand that trauma and poor mental health are transmission factors for HIV and other diseases. The current assumption, she says, is that some people are to blame for their health problems. 
Specifically, Mandefro hopes the film will spur health care providers to screen patients for trauma and mental health problems and refer patients who report these problems to the proper service providers. She also hopes the film will encourage insurance companies to cover health problems associated with trauma and poor mental health. 
“I want to make it harder for physicians to ignore mental health,” she says. “Right now, at least in primary care medicine, we’re trained to not deal with it. We don’t ask about it. And we’re not trained to treat it.” 
Screening for trauma and poor mental health, she believes, will help providers treat their patients and will help patients prevent, manage and recover from illness.
She cites her own experiences with patients suffering from poor health as a result of traumatic experiences as the genesis of the documentary. In one case, Mandefro treated a patient for invasive cervical cancer and advised her to avoid intercourse for two months afterward. The patient could not follow this order because her partner beat and raped her. She eventually died from an overdose of pain medications. 
“That’s when the lights went off,” Mandefro recalls. “Her other medical problems fell by the wayside because of the problem of violence.” 
That experience was on Mandefro’s mind when she applied for the Foundation’s Health & Society Scholar program, which enables outstanding doctorally-prepared researchers to explore the various determinants of population health. 
During her two-year fellowship, Mandefro focused on teaching and communicating about societal determinants of health. She found film the best way to transmit health information because it offers accessible information to large-scale audiences. 
In the future, Mandefro plans to keep up her work as a physician, but also to continue to pursue her passion for filmmaking. She is currently working on a second film about women’s rights and justice in Ethiopia and is doing outreach for another film about a Jewish girl who as a teenager discovers she is half-black. 
“I’m not sure what good it does just talking about health information within our walls,” she says. “Film is a wonderful way of getting that information to the people who need it most.”