Reluctant doctor finds her passion helping women, children

Purnima Madhivanan’s, PhD, MBBS, MPH, mother knew something her daughter didn’t realize: she could change the world.

Madhivanan, an associate professor of health promotion in the University of Arizona Mel and Enid Zuckerman College of Public Health, did not want to become a doctor. But because she listened to her mother and went to medical school, countless underserved women and children in India are living longer, healthier lives, and students in the Zuckerman College of Public Health have access to internships, fellowships and research opportunities in a center she founded in India.

Madhivanan’s global health credentials and clinical service have extended the reach for UArizona students and faculty interested in global health and service in the developing world. She is the director of the Global Health Equity Scholars Fellowship Program in collaboration with Stanford University, Yale University and the University of California, Berkeley. She is currently mentoring about 35 students and junior faculty.

“I was never interested in medicine,” said Madhivanan. “My idea was to get rich quick, so I wanted to become an engineer and get an MBA. I had a very clear path in my head, but it didn’t work out that way.”

Madhivanan grew up in India with her older sister and younger brother, raised by her widowed mother. Her mother’s determination to provide a better education led her to move the family away from their extended family in a rural area to the big city. That inspired Madhivanan, who is also a member of the UArizona Cancer Center and BIO5 Institute, to focus much of her work on women and children.

“Since my sister didn’t get into medicine, my family made the decision that I would become a doctor. In Indian families it’s predictable, you must have a doctor or engineer,” she said with a laugh.

Running group leads to career path

While she took the path her family wanted, Madhivanan still wasn’t sure what she wanted to do with her career. “I took a break after medical school,” she said. “I wanted to evaluate what it was that I wanted to do with this degree because just practicing medicine was not of interest to me. It sounded too boring.”

During the break, a friend in her running group told her about a doctor who was having a hard time finding another doctor to work part time in a clinic she had started. 

“It turned out to be a nonprofit organization providing medical support for people living with HIV,” said Madhivanan. “This was the late ‘90s, and there was a lot of stigma associated with HIV diagnoses. And that was the reason she couldn't find other doctors, because nobody wanted to be associated with treating people with HIV.”

Madhivanan said she had no HIV training but was intrigued by the opportunity. “This was how I actually learned medicine the right way – literally from scratch – because HIV care was not taught. So, we got the Johns Hopkins Medical Handbook, and I would just look it up. And that's how I got passionate about HIV care and management.”

It was this experience that led Madhivanan to start the first women and children's clinic for HIV in India. Madhivanan, who speaks five languages, treated women and children from all over the country. She began to think about how prevention, not just treatment, should be part of their work. At the clinic, she collaborated with several medical students from Brown University, where she occasionally visited on a short-term HIV epidemiology fellowship. One of those students asked if she had ever thought of getting a master’s in public health, something she had not considered until then.

A high-fidelity interlude

While on one of her fellowship visits to Brown, she was walking down a street near the university and heard music coming from the outdoor speakers of a record shop. Drawn to the music, she went in to buy a CD of what she heard.

One of the shop’s owners, Karl Krupp, PhD, was playing the music for a customer. “Purnima walked up to me and asked what CD was playing and said she wanted to buy it,” Krupp, now an assistant professor in the Zuckerman College of Public Health, reminisced. “I told her she couldn’t buy it because it was already sold, and I didn’t have another.”

“I was so mad,” Madhivanan said with a laugh. Krupp told her he would help her find other music. “I told her she would not leave the store without a CD. We spent the next two or three hours going through music together.”

They started dating long distance as she continued her work in India and began looking into MPH programs. She applied and was accepted to a program at Berkeley. Three years after they met, Madhivanan started an MPH program at Berkeley. Krupp joined her there and they have been collaborating ever since.

From research concept to institution

After earning her MPH in epidemiology, she began a doctorate program in epidemiology at Berkeley. Madhivanan and Krupp moved to India while she conducted her dissertation research, but she faced roadblocks because she was a young woman in a traditional Indian culture. So, she and Krupp took matters into their own hands.

“We started the Public Health Research Institute of India,” she said. “I trained women from the community with no degrees to be interviewers and recruiters. I was able to do a cohort study with 900 women we recruited and followed over a period of time with 95% retention.”

Once the research was completed for her dissertation, Madhivanan and Krupp had to decide what to do with the institute that the community and other research teams had embraced.

“We decided to keep it open, and so we sold all our belongings and put everything into the clinic,” she said. “Fast forward 15 years now, and it has 27 staff, two mobile clinics and a molecular lab. It's an NIH training site for doctoral and postdoctoral candidates, and I have undergraduate and graduate students coming to get trained in community-based research regularly.”

PHRII continues to serve as a research hub for Madhivanan and Krupp’s research as well as a support center for researchers and students from around the world.

In time, the couple decided that their daughter Paavlena, who has special needs, would be better off in the U.S. Madhivanan completed her postdoctoral training at the San Francisco Department of Public Health running sexually transmitted disease clinical trials before taking a faculty position at Florida International University in Miami in 2011. Eight years later, she and Krupp moved to Tucson and joined the Zuckerman College of Public Health in 2019 to develop the global health program.

Invested in women’s health and education

A pattern in Madhivanan’s career has been focusing on women and children’s health while teaching people in underserved communities to support and advocate for those communities. She attributes this to strong female role models, not the least of which was her mother, who passed away in January.

This past February, Madhivanan started a four-month research project with female cancer survivors, at PHRII in Mysore, India, looking at needs and support systems in their community as part of a Fulbright Distinguished Scholar Fellowship she was awarded last year. In April she worked on a mixed-methods human papillomavirus vaccine study to examine catch-up HPV vaccine acceptability among emerging adults, also in India. In October, she is headed to Toronto to receive the 2023 American Association of Cancer Education Endowment Award for her work this summer in India.

“During my HIV care days, I noticed that if a woman died in a family, that family shattered,” Madhivanan said. “When the man died, the woman was still able to keep the family together. So, if I can keep a woman healthy, I know her family is going to be healthy.”

In much of Madhivanan’s research and clinical programs, she has hired and trained women within the communities and pre-existing social groups to do the work to support and strengthen their community’s health and well-being.

“I think the overall objective of anyone doing this type of work should be to try and get ourselves out of the equation,” she said. “If we can make them self-sufficient, train them to be independent, then that’s an achievement.”

Keeping grounded

Madhivanan is one of those people who needs the extra pages in her passport to keep from filling it up too quickly. Between her research, student programs, speaking engagements and teaching, it’s hard to imagine she can fit anything else into her life – but she does.

“The one thing that I absolutely do not compromise on is my food,” said Madhivanan, showing shelves full of glass jars filled with fresh spices from her travels. “I love to cook. So, the day when I can get myself out of a job, my plan is to write a cookbook. I take cooking classes in any country I go to. Really, family, food and music are what keep me sane.”