The Doctoral Chair, Month One

What it feels like to be a student again, with seventeen years of questions.

Disclaimer
Field Notes reflect the editorial analysis and personal reflection of the Managing Editor, informed by direct professional experience across Caribbean healthcare systems. These observations are the author’s own and do not represent the official positions of any government, institution, or commercial partner.

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In the final part of The Soft Side, I wrote that I had put myself back in the student’s chair. I promised to be honest about every turn. So here is an honest report from a few weeks in.

I am a Doctor of Public Health student at the George Washington University’s Milken Institute School of Public Health. Seventeen years after Antigua, I am once again someone who reads before a deadline, who sits in a virtual or physical room waiting to be called on, and who is surprised by how much I still have to learn.

Going back to school mid-career is not like going back at the start of one. You arrive carrying the questions that the work has already asked you.

What Is Different This Time

The first thing I noticed is that I read differently. When I was a younger student, I read to absorb. Now I read to test. Every framework gets held up against a specific hospital, a specific ministry, a specific morning in Montserrat or another environment where I have accumulated experience. Some of them hold. Some of them bend. A few break, and those are the ones I now underline twice.

The second thing is vocabulary. Practitioners and academics often describe the same reality in different languages. What I have called, for years, the soft side of health systems has several formal names in the literature: health systems strengthening, implementation science, organizational culture, and more. Being reminded of those words is not about replacing my own. It is about being able to carry my practice into rooms that run on theirs.

What Practitioners Know That the Literature Is Still Catching Up To

Working inside an entire small health sector gives you knowledge that is hard to footnote. You learn how long a policy really takes to land. You learn which relationships make a digital rollout succeed and which ones quietly sink it. You learn that “stakeholder engagement” is, in a small island state, just a long list of people you will see and speak to again next week, and possibly see at the grocery store after work. The literature often treats small states as a footnote or a special case. A doctoral program is, among other things, a chance to ask whether they might instead be a starting point.

What Has Been Hard

I will be candid: the calendar. Balancing the work in Montserrat, the editorial rhythm of Caribbean Currents, and a doctoral reading load is a real exercise in discipline. Decluttering my life was mandatory before starting the program. I am learning to protect time the way I used to ask others to protect budgets: deliberately, and in advance.

What I Am Carrying In

I came to this program with a handful of questions that the last seventeen years would not let go of. How do small systems sustain themselves over time? What does it take to resource the human side of a health system as seriously as the physical side? How does knowledge held in the heads of a few practitioners become knowledge a region can keep? I do not expect the program to hand me answers. I expect it to give me better tools for asking.

If you are a practitioner thinking about a return to study, my only advice after a few weeks is this: go when you know what you are carrying. The questions are the real tuition.

I will report back as it unfolds.

Go when you know what you are carrying. The questions are the real tuition.

Field Notes is the weekly reflection column of Caribbean Currents, published each Sunday.

About the Author

Mary Miller Sallah, MHA is the Managing Editor of Caribbean Currents and a healthcare leader with lived experience across Caribbean health systems. Her work focuses on health system transformation, leadership under constraint, and the practical realities of implementing change in small-state environments. She writes regularly on healthcare reform, digital health, and regional leadership.