Research

Student Researches Health Disparities During Practicum in Colombia

MPH student Almira Lewis spent two months in Colombia this summer conducting research on disparities in cervical cancer mortality as part of her practicum through the Cancer Epidemiology Education in Special Populations (CEESP) Program.

Almira Lewis comes from a family of inquisitive, bright Dominican women. Her mother, who worked at a credit union to support Lewis’s twin younger siblings, has a talent for mathematics, and her two older sisters earned their respective degrees in accounting and medicine. Growing up, Lewis learned from their example to constantly ask questions about the world around her and to seize educational opportunities whenever and wherever they arise. Her thirst for answers has led her thousands of miles away from her childhood home on the Caribbean island of Dominica.

Lewis, a second-year MPH student specializing in global health at the School of Public Health, recently conducted research in Colombia for her practicum. Under the guidance of Isabel Garcés-Palacio, a professor of public health at the University of Antioquia, Lewis investigated disparities in cervical cancer mortality.

“It was life changing because I had never written a research manuscript, and to go from nothing to having three in one summer—it was intense,” says Lewis, who left Colombia with two first-author papers and was recently added as a co-author on a third. She is now in the process of getting the papers reviewed by journals. “One opportunity just bled into another, which was beautiful.”

Lewis credits SPH’s Career and Practicum Office, particularly Joe Anzalone, the assistant director of advising, with making her trip to Colombia a reality. Feeling anxious about finding a practicum, one day last spring she wandered into the Career and Practicum office suite on the second floor of Talbot and despite not having an appointment, she remembers Anzalone warmly invited her into his office.

“We had a conversation about what my needs and wants are—not just for my practicum, but also long term—and I really emphasized a need to combine global health with policy, especially as it relates to health equity,” says Lewis. She also told Anzalone that as an international student on a scholarship, she would need a paid position. His response, Lewis says, was, “I have the perfect practicum for you.”

Anzalone recommended that Lewis apply to the Cancer Epidemiology Education in Special Populations (CEESP) Program. Since 2006, CEESP has provided funding to graduate public health students from schools and programs of public health across the country to travel and conduct mentored cancer research in global and US minority settings.

Marie Daniel, the director of advising and employer engagement at SPH, lent Lewis her office for the interview. Once accepted, Lewis applied to Generation Health, SPH’s new initiative to fund student practica. Her application qualified her to receive a Santander Travel Award to supplement her CEESP funding. Between the two programs, Lewis says, her practicum abroad was fully funded.

“I do my best to share the CEESP opportunity—every year, we host an info session with Director Dr. Amr Soliman, we push it out in our newsletters and when meeting with students, but you never know who will rise above and submit a compelling proposal,” says Anzalone. He attributes Lewis’s successful application to her willingness to work hard and incorporate feedback, on top of many other strengths that include a gift for public speaking.

Over the course of her two-month stay in Colombia, Lewis developed a routine. Once per week, following her customary breakfast of fried plantains and cocoa tea—staples back home in Dominica, she says—she would visit Garcés-Palacio in her home. The two would spend a couple hours strategizing together, then Lewis would go back to her Airbnb and execute their research plan.

Analyzing data from Colombia’s national statistics department, Lewis compared outcomes for patients with private health insurance to those of patients with public insurance. She was particularly interested in how a 2008 Colombian Constitutional Court decision affected the two groups, she says, as the decision essentially mandated that everyone have equal access to care, regardless of their insurance type.

In theory, Colombians have a right to health, but Lewis’s research reflected a different reality. Universal healthcare coverage does not automatically equal universal healthcare access, she says. She found that while cervical cancer mortality increased in both groups in the years leading up to and following 2008, mortality increased most for those with public insurance. Not only does this have important implications for health equity in other South American countries considering universal health insurance, Lewis says, but also for countries like the US, where, despite residing in a high-income country, Black and brown people face similar barriers to accessing care.

Lewis’s observations of racial health inequities in the US were what first inspired her to pursue her MPH. An international affairs and Spanish major at Midwestern State University in Texas for undergrad, Lewis took a job at a US health insurance company after graduation. In the course of processing customer claims, she noticed a troubling pattern. She says that while Dominica has a majority Black population and everyone has access to community health centers regardless of their ability to pay, in the US she realized most of her Medicare and Medicaid claims were on behalf of Black and brown people. “Why are so many of us on public insurance? What does that mean?” she wondered.

Coming to SPH and completing a practicum through CEESP allowed her to explore these difficult questions and more, Lewis says. “Honestly, it’s been the best decision. When I found out about public health I said, ‘That’s my calling. That’s it. That’s the thing I’m meant to do.’”