It is rare that a high school class trip proves life-changing. When Hermioni L. Amonoo, MD, MPP, of the Department of Psychiatry, was still a high school student in her native Ghana, she and her peers visited one of the country’s three psychiatric hospitals as part of a community service program to speak with patients and determine how they could help fulfill the hospital’s needs in their own small way. It was the first step on a journey that would take Amonoo into the field of psychiatry.
“Frankly, I was — everyone was — a little nervous,” she said, emphasizing the extent to which mental health is stigmatized in Ghana and many low- and middle-income countries.
“The community I grew up in often ostracized patients with psychiatric illnesses, but I think a lot of us left the experience blown away,” she said. “I was humbled. I could see a lot of my neighbors, friends, and relatives in these patients, and I left with a strong sense of wanting to do something about changing stigma and increasing access to mental health services in Ghana.”
Following high school, Amonoo attended Purdue University in Indiana, and subsequently Harvard Medical School (HMS). She quickly took advantage of the abundant opportunities at HMS to work with individuals with psychiatric illnesses, volunteering at the Manville School for children with behavioral and psychiatric challenges. She returned to Ghana after her first year at HMS to complete a research project in collaboration with the Minister of Health in Ghana at the time.
Working with the ministry of health was eye-opening. Recognizing the impact of governmental influence on individuals’ health and wanting to sharpen her own fluency in legislative processes, Amonoo decided to obtain a Master in Public Policy at the Harvard John F. Kennedy School of Government in conjunction with her medical degree at HMS. Armed with tools in health care policy, Amonoo started residency in Psychiatry at Massachusetts General Hospital (MGH) and McLean Hospital eager to work with leaders in Global Mental Health. With funding from the Partners HealthCare Centers of Expertise in Global Health, she visited the Psychiatry Department at the University of Addis Ababa in Ethiopia as a second-year resident to learn more about medical educational partnerships between developed and low-income countries — a viable model to help low-income countries train the next generation of psychiatrists.
But Amonoo also found herself growing increasingly cognizant of career advice offered by MGH mentors, including David Henderson, MD, and Theodore Stern, MD.
“They really pushed my thinking about how to do the work I thought I wanted to do,” she said. “It’s one thing to want to go around the world and fix problems. But you also need to become an astute clinician here, in the U.S., and gain credibility. That was a bit of a paradigm shift for me, and so I started to lean more into my clinical training and think about what my clinical niche should be.”
A Pivot Toward Research
Near the end of her residency, Amonoo’s close friend, a surgeon and fellow global-health advocate, developed breast cancer in her early 30s, passing away within six months. Amonoo, who had already begun to develop an interest in medical psychiatry and consultation-liaison (CL) psychiatry over the course of her residency, soon decided that she wanted to pursue a fellowship in psychosocial oncology and CL psychiatry, which brought her to the Brigham and the Dana-Farber Cancer Institute (DFCI) in 2016.
The fellowship placed Amonoo, for the first time, in direct contact with cancer patients who were receiving hematopoietic stem cell transplants (HSCT), sometimes referred to as bone marrow transplants. The procedure is notoriously rigorous, requiring patients to withstand high doses of chemotherapy before the transplantation. These patients then battle immediate and long-term side effects, which can range from infertility to low levels of essential blood cells.
“I was completely fascinated by their whole experience and what it entailed,” she said.
Just before transitioning to her clinical fellowship at BWH and DFCI, Amonoo happened to have a casual conversation about research with Jeff Huffman, MD, associate chief of psychiatry at MGH and the director of MGH’s Cardiac Psychiatry Research Program, while waiting to board a train home. The encounter jumpstarted her pursuit of a career as a physician-scientist. While her focus on cancer patients differed from his research focus of developing behavioral interventions for patients with cardiac disease and other chronic illnesses, he agreed to mentor Amonoo, who wanted to gain the research and grant-writing skills that could bolster her impact as a psychiatrist. She hoped these skills would ultimately open new doors in the fields of global mental health and public policy.
Under Huffman’s mentorship, along with the support of the HMS Dupont Warren and Livingston Research Fellowship Grants, Amonoo began developing a psychological intervention to help HSCT patients feel more optimistic about their futures, despite the challenges of their treatment. In 2019, she received a Faculty Career Development Award from the Brigham’s Office for Research Careers to support the project. In pilot studies, Amonoo’s team found that their positive psychological intervention was feasible and associated with promising improvements in participants’ perceptions of their own resilience. They also reported that the pilot fostered a sense of community and social support amidst their recovery. Amonoo’s work, currently funded by the National Institute of Health-National Cancer Institute Mentored Career Development Award (K08), aims to further refine and test her intervention to inform future efficacy trials.
“It is so powerful to be able to do research,” said Amonoo, citing the way her work has been shaped by insights from mentors including Huffman, Areej El-Jawahri, MD, William Pirl, MD, MPH, and Hadine Joffe, MD, MSc. “I start a lot of my intervention development work with qualitative interviews, spending hours with patients, trying to understand their problems. I can hear what patients are saying, understand what their struggles are, come up with a research question, and then articulate it in such a way that is viable for investigation that will eventually impact patient care.”
Maintaining Patients’ Personhood
While Amonoo’s interests have evolved through her academic years, she is confident that her winding path will ultimately allow her to help bring meaningful change to global mental health.
As the associate training director of HMS and the Brigham’s Psychiatry Residency Training Program, she also plays a critical role in helping shape a psychiatry residency training program for future leaders in psychiatry. Through her research and clinical practice, she continues to ground her work in preserving the individuality of the patients she encounters — a value she first recognized as a teenager, visiting a psychiatric hospital.
As Amonoo describes it, “Whenever I go to see a patient, I ask myself, ‘Who is this person? Who is this human being in front of me, and who else is helping them navigate their world? What internal strengths and resources do they have, regardless of their cancer diagnosis?’ And how can I help them make their mental health tool-box robust as they manage these life-threatening illnesses?”
“As a psychosocial oncologist, I can get to know patients and make sure that their personhood is not lost in the midst of everything else that’s happening,” Amonoo said. “I can just sit down, and focus on the person, and I think that is a real privilege.”