Watson Fellow Livia Cox ’22 Studies Pain

by Miki Lynch

What is pain? Why do we experience pain? Is pain perceived the same way across different cultures? To answer these questions one might ask Livia Cox ‘22, a Thomas J. Watson awardee who spent her fellowship year studying the connection between cultural, political, and social definitions of pain.

The Watson fellowship is a unique opportunity for chosen fellows to travel the world for one year to explore a project of their own design. Cox’s project named Pain, Policy, and the Person has taken her to diverse countries from France to Dominica. In the process, she has visited even more diverse places like birthing clinics and indigenous medicine clinics, places where pain is a common thread in their daily operation. 

Cox returned to Wesleyan during international orientation week to deliver a presentation on her experience, sharing with listeners what she learned during her year abroad. This article will briefly share her insights and experiences, detailing what she had to say while looking back on her travels from Middletown to Kenya, Tanzania, France, Portugal, Nepal, Mexico, and Dominica.

To begin her presentation, Cox emphasized Wesleyan as a stepping stone to finding her interests in pain medicine and Middletown as a nursery where her Watson project proposal idea was born. Believing that the ability to apply one’s knowledge to their community allows them to connect with others, Cox applied what she learned from Wesleyan as a neuroscience and science and society major to her experience as an EMT in Middletown. This collective experience brought her to consider questions like “Why do people experience things like addiction, pain, and suffering?” While working, she mentioned that she witnessed both successes and losses: with overdoses, Cox said, “It’s one thing when they overdose, and you feel great because you’re able to give them Narcan to save their life but it’s another thing when they die. And it’s another thing when you stop seeing them on Fridays and don’t know what’s happened to them.” 

Livia Cox ’22

The Center for Disease Control reported that in 2023 one class of drugs was involved in 75.4 percent of all drug overdose deaths. The type of drug? Opioids. Cox says this presents problem number one: the use of dangerous drugs which can lead to overdose. But she also mentions problem number two which involves asking why individuals are compelled to take these drugs in the first place. Well, “We’ve got a world of people for whom pain is ubiquitous. And unless you’ve got a problem with you, neurologically or biologically, you can feel pain, right? This is a new, ubiquitous thing, and it’s being under-addressed,” Cox explained. 

The types of pain – chronic pain, mental pain, physical pain – from a neuroscientific point of view are neurologically related. The perceptions of this pain culturally, even more so. One might even be surprised to hear from Cox that in a different part of the world, pain is not seen as a problem, and, instead, celebrated. 

With this introduction, Cox’s journey begins in Kenya which has the highest rates of home births and one of the lowest rates of epidurals of all countries in the world. Her focus in Kenya, therefore, was labor pain. In assisting a doula, Cox observed both home births and births at informal settlements where patients (many of whom had to travel from rural areas just to get help for birthing) queued for treatment outside or in lines that went around the block. One thought Cox considered during this time was, for the parents who could afford them, why home births were preferred over hospital births. The answer, she described, lies in policy; in Nairobi, hospitals were required to have birthing patients lie on their backs as a policy. This birthing position is not the most efficient as proven scientifically, but hospitals there are not equipped with the time or space to have patients sitting upright or using birthing balls – both can be considered as the preferred positions for a person to give birth as it they can make use of gravity and be more comfortable.

After her time in Kenya Cox visited Tanzania. There, Cox says she learned much about the differences in access to opportunities and resources based just on where one happens to be born in the world. As an example, Cox mentioned a father who was unable to provide his son with malaria medication. The son passed away as the father was forced to sacrifice his son’s medicine to ensure that the mouths of his other children remained fed. Cox implored listeners at her talk to consider how in some regions of the world, lives are subject to a cost-benefit analysis, and things as simple as access to medical care is a right to be grateful for.

On top of this personal connection, Cox also observed to lack of harm reduction resources and a lack of additional resources. She began making a change by founding the Middletown Harm Reduction Initiative, a non-profit that seeks to offer harm-reduction care to the Middletown Community. What pushed her in the direction of looking at pain for her Watson project was a survey she conducted for her senior thesis where she asked clients at her non-profit for their reasons for using drugs. She found that 93.7 percent of respondents cited their main reason as pain. 

Keeping this message in mind, Cox traveled to Paris. Compared to Tanzania where many struggled with access to medical care, the hospital Cox worked at in Paris had many luxuries like the resources to make medical care more efficient. One notable example she mentioned was PCA pumps. Cox explained that these pumps are devices that can administer pain medicine and can be controlled by the patient. Again, Cox emphasized the perspective that having access to these kinds of medical interventions is not always universal. 

Cox continued on to Portugal where she was interested in researching the policies that surround drug decriminalization. Cox spent her time there working in and learning about supervised drug consumption rooms. She described the unique environment where “People are talking and people are laughing people are making plans to get lunch after. It’s amazing. The same camaraderie and friendship that comes from community care, not from drug use, but from communities looking out for each other.” At the same time she also grappled with the social aspect of the policy where she considered the policy’s merit if it was “A policy that was made on the product of stigma,” as was described to her by those she met there. 

Taking another turn, Cox then spent time in Nepal thinking about Hinduism and Buddhism. She asked the indigenous community members about their pain, gaining knowledge about the traditional practice of Ayurveda. She explained how the discussions she had reaffirmed her belief that engaging with the community was the best way to learn; she mentioned how “Many of the people [she] spoke with expressed that the reason that they were feeling pain had relations to Karma and punishment.” Because of this belief, she was in a position to consider her perceptions of pain management and how they differ. In this situation, she mentioned how she began to think about health policy from the standpoint of religion, “Something she felt discouraged to do here in what we claim very secular society. It is very interesting to think about how people’s actual individual beliefs do govern policy, whether or not policy themselves are informed by them.”

Finally, at the end of her presentation, Cox spoke about her experience in herbalism and natural medicine in Dominica and Mexico. In Dominica – a small country in the eastern Caribbean – Cox trained in wilderness medicine and learned many fascinating techniques like making tourniquets out of sugar cane and curing a sider bite with celery, cayenne pepper, and honey. Similarly in Mexico, working with a traditional herbalist healer Cox emphasizes the experience as valuable in learning about medicine globally where, at times, it was difficult; Cox mentioned, “People came in with stage 4 pancreatic cancer were told that cinnamon was a cure, and that went against so much of what I learned in school. I’m not saying I’m naive to these things and naive to the idea that different alternative and complementary medicine systems exist which are not always in concurrence with biomedicine that I’ve learned. But it was really important for me to kind of challenge my own assumptions about what might be quote unquote, better.”

In closing, Cox’s experience is inspiring and emphasizes the value of learning to become a global learner. In this article alone covering Cox’s presentation one can get a sense of how vast the world is in medical options, healthcare outcomes, and pain management medicine. Hearing from Cox, one can consider the world for what it is: a vast collection of cultures where universal feelings – like pain – are linked to perceptions that may not be so universal. When speaking about healthcare and pain medicine, the topic is multifaceted as Cox has discovered where factors be it religious, political, or cultural come into play. 

Currently, Livia Cox is pursuing a master’s in public health at Yale University and planning to apply to medical school, where no doubt she will break more barriers to advance public health and global health to minimize pain for all. 

This article was originally published in the Inclusion in STEM Blog.

Watson Fellowship applications for the Class of 2025 open on May 1 and will be due October 12, 2024 at noon. All citizenships and all majors are eligible; only rising seniors can apply. Students should plan to reach out before they leave campus for the summer to get connected with resources. Reach out to fellowships@wesleyan.edu if you are interested in applying.