What Naghan Taught Me That Yale Never Could
I've spent years in places that look impressive on a CV: chief resident at Shahid Beheshti University of Medical Sciences, postdoctoral fellow in Dr. Hugh Taylor's lab at Yale, residency training in the United States. But if I'm being honest about where my understanding of medicine actually changed at its core, it wasn't in a research lab or a teaching hospital. It was in a small mountain village in western Iran called Naghan, where I accepted a health systems adviser role with a modest stipend and a housing allowance, and almost nothing else.
I made that choice right after residency, when most of my peers were moving into established clinical positions. At the time, I told myself it was the right thing to do. Looking back, I'm not sure I fully grasped what I was walking into. Naghan wasn't a temporary rotation or a short-term mission. It was three community hospitals serving people in a resource-limited, geographically isolated area, and I was being asked to help those hospitals function better. No large team. No deep institutional budget. Just the work itself.
What I thought then: that good medicine was primarily a clinical problem. You trained hard, you learned the science, you developed strong diagnostic skills, and patients got better. I was a new attending, confident in what I'd learned. I believed that competence was the engine and everything else was secondary. Naghan dismantled that belief within the first few months.
Here's what I discovered. A hospital can have skilled people inside it and still fail the community around it. Supply chains break down. Staff turnover in rural areas is relentless because clinicians leave for cities. Patients delay care not because they don't want it but because trust in the system has eroded over years of being underserved. The clinical problem is often the last problem, not the first. If you can't keep a qualified nurse on staff, or if a village elder doesn't trust the facility, then diagnostic precision is almost beside the point. I had to learn quality improvement, community relationship-building, and systems thinking on the ground, without a playbook.
The shift in thinking that still matters to me now is this: health outcomes are built upstream. They're shaped by decisions made long before a patient walks through the door. I carry that into everything. It's why my research has reached into socioeconomic disparities in women's health alongside the basic science. It's why, when I joined the Integrated Refugee and Immigrant Services work in Connecticut, the clinical piece felt familiar but the systems piece felt urgent. People navigating new countries face exactly the kind of upstream barriers I first learned to recognize in Naghan. The faces change. The structure of the problem doesn't.
I also want to be clear about what I got wrong at the start of that experience. I arrived thinking I could improve things by identifying inefficiencies and fixing them. That framing is too narrow. Real improvement in a community setting requires the community to trust that you're there for them, not to document them. That takes time I didn't think I'd need. It was the single most humbling professional correction I've received, and it came not from a supervisor or a peer reviewer but from the people I was supposedly there to help.
When Elham Neisani Saman reflects on the arc of a career that has moved across continents and disciplines, Naghan sits at the center of it, not because it was the most prestigious stop, but because it was the most formative. Every patient I've cared for since, including those paralyzed by grief after recurrent pregnancy loss or quietly suffering postpartum depression, has benefited from what that village taught me about listening before solving. You can read more about the values that shape my practice on my about page.
I share this because I think medicine trains people to lead with expertise and follow with empathy, when it should probably be the other way around. That's the order I'm still working to get right. And it's the principle I hope to pass on to every medical student and resident I have the chance to mentor.