When Geetha Jayaram, M.D., M.B.A., sat down to interview for the Johns Hopkins psychiatry residency program after graduating from medical school in India in the 1970s, she fielded an important question: if gifted physicians continually come to the United States to pursue training and a career, how does this affect patients living their native countries?

"This question has always stayed with me through the years of raising my family and making a life for myself" in the United States, Jayaram told Psychiatric News.

Though she tried unsuccessfully to obtain a job as a psychiatrist in India after completing her training at Johns Hopkins in 1981, she has made up for lost time by returning to her native country 20 years later to ensure that people living with mental illness in remote villages receive the care they need.

"I can now give much more than what I could have if I had lived there," she said, referring to the considerable experience she has acquired in the United States as a community psychiatrist and academician.

She is an associate professor of psychiatry at Johns Hopkins and physician advisor in the Department of Psychiatry and also maintains a private practice.

It is perhaps her work as a community psychiatrist that best prepared her for the work she would undertake in India.

As director of mental health in Prince George's County, Md., in the 1980s, Jayaram ensured that public-sector patients with serious mental illness would receive continuous care by organizing a network of physicians who would travel between community mental health centers in the county and continue seeing patients during periodic hospitalizations. "This seemed like a small thing to do, but it had never been done before," she noted.

In addition, she organized an outreach effort in which county vans that had previously been sitting idle circulated around the community to pick up patients and bring them to a clinic where they could receive depot prolixin injections.

"After receiving their treatment, the patients would frequent the local businesses. They began to look forward to these outings. It was like a social day for them," Jayaram said.

In subsequent years, Jayaram would go on to direct a 1,000-patient community psychiatry clinic and the AIDS Psychiatric Evaluation Unit, both of which are affiliated with the Department of Psychiatry at Johns Hopkins. It was under Jayaram's leadership that the clinic won APA's Psychiatric Services Gold Award in 1989.

Throughout her career, Jayaram has been interested in ensuring that psychiatric services are run efficiently. In the 1990s, she fine-tuned her administrative skills by earning an M.B.A. from Johns Hopkins after taking a position as physician advisor in the hospital's psychiatry program.

As physician advisor, she oversees the quality of psychiatric services offered at Johns Hopkins. She is responsible for issues related to credentialing, risk management, and adverse medical events and supervises a staff of more than 200 psychiatrists.

"The physician advisor's work has become increasingly important with the emphasis on quality of care and safety in the medical arena," she noted.

She also teaches psychiatry residents about these issues during rounds on morbidity and mortality. She chaired APA's Scientific Program Committee in 2003 and 2004 and currently serves on the PsychiatricNews and Focus editorial boards.

As her career unfolded, the question posed to Jayaram as an international medical graduate on the brink of a career in the United States would one day take center stage in her professional life. That is, how could she help underserved populations living in her native country?

Humanitarian work runs in Jayaram's family. Her father was a philanthropist and "trained us to help the poor and under-privileged" by providing them with education and employment opportunities, she said. He was also a lifelong member of the Rotary Club, an international service organization of professionals who provide humanitarian services around the world.

Jayaram has two brothers living in India who perform humanitarian services as Rotarians. A third brother, who has since died of leukemia, raised hundreds of dollars as a Rotarian to establish a blood bank in Bangalore, India.

Jayaram joined the Rotary's Rotaract youth service club and met her husband, Jay, as a young Rotaractor in India when she was 19 and he was 23.

Rotaractors are members of the Rotary's youth service club who perform community and international service projects.

So when Jayaram decided to organize a mental health outreach project in India, it seemed only natural that she would raise the funds through the Rotary Club.

Through the Rotary Club of Columbia, Md., Jayaram raised $25,000 by organizing workshops for women throughout India and received a matching grant through the Rotary Club in 2002.

The money enabled her to hire a team of health care workers to conduct a door-to-door survey of approximately 17,000 households in 30 villages outside of Bangalore and to screen people for mental health problems.

Those who screened positive for psychiatric symptoms were brought to a mental health clinic established by clinicians from a local medical school to be evaluated. A local psychiatrist visited the villages on a weekly basis to treat those with psychiatric symptoms.

Jayaram and her team studied 300 of the villagers who received treatment for depression.

Using the Structured Clinical Interview for DSM-IV-TR, they confirmed diagnoses of depression in more than 200 patients, the vast majority of them women.

"Women are twice as likely as men to suffer from depression and anxiety, and their needs are often ignored" in Indian culture, she noted.

Using the Hamilton Depression Rating Scale, they found that 129 of this group had significant depression six months after their initial treatment. Depression had remitted in 72 of the patients.

They also found that comorbid anxiety was a significant factor in those with persistent depression.

Jayaram plans to raise more funds through the Rotary to ensure that those with depression continue with treatment. "Many of the villagers live hand to mouth" she said, and cannot necessarily afford to take time off from working in the fields to receive treatment at the clinic."

The additional funds would permit case-workers to go to patients' homes with medicines, she added.

Jayaram has also provided volunteer services for the Maryland Psychiatric Society and the Disabled Persons Review Boards for two decades. "My humanitarian work is gratifying and brings much meaning to my life, and hopefully to the lives of others as well," she said. ▪