Photo credit: Jessica Valdez Outlasting Memories.

I am the proud daughter of two amazing parents who emigrated from Mexico in pursuit of the American dream and the hope for a better future for their children.  Despite their long work hours, my father as a factory worker and my mother as a seamstress, they always stressed the importance of education.  We learned through their hard work and motivation that good grades and college were the only option for a better future. 

I was the first person in my family to attend college.  I earned a Bachelor of Science degree in health education at California State University, Northridge and furthered my passion for health education at New Mexico State University (NMSU), where I obtained a Master of Public Health (MPH) degree.  But it was the opportunity, mentorship and influence of Dr. Luz Claudio that inspired me to obtain my Doctorate in Health Education after completing a physician assistant degree.  Little did I know my pursuit of a doctorate would serve as the catalyst to that which makes me most proud: the opportunity and experiences of serving individuals and families in underserved communities.  These opportunities have fulfilled my moral desire and innate obligation to give back.

While obtaining my MPH at NMSU in Las Cruces, I worked for the New Mexico Department of Health.  Much of that work was spent investigating the indoor toxic pollutants that exacerbate asthma, specifically in the rural communities in and around Las Cruces.  This work was so impactful to my life that I continued to conduct research on childhood asthma in vulnerable populations.  It was during that time I learned of Dr. Luz Claudio’s Environmental Research Program.  So after completing my first year at NMSU, I applied to the program and was subsequently selected as a participant for the Summer 2002 program.  

This opportunity allowed me to further research childhood asthma as a participant of the Environmental and Occupational Fellowship Program at the Department of Environmental Medicine and Public Health at Mount Sinai in New York.  This experience forever shaped my life as a health care provider and advocate for our most vulnerable populations.  I attribute the success of this experience in large measure to the leadership and mentoring of Dr. Luz Claudio and to the other remarkable program participants.

As part of the program, my research involved developing and disseminating materials to families who repeatedly experienced asthma exacerbations and included developing and evaluating culturally effective asthma education programs for communities in and around Harlem, New York.  Given the prevalence rate of childhood asthma, which was strikingly high, we noted alarming hospitalization rates in this population when compared with those living in affluent communities.  We attributed much of these results to a lack of health care resources and information within these communities.  Given the many families using the emergency room for medical care services coupled with the limited time emergency room physicians have to treat patients, we determined that this population had significantly limited comprehensive health care, which is necessary for treating chronic conditions like asthma, and required better patient education about the condition and preventing exacerbations.
​
My role in mitigating the disparities between the social determinants and inequalities of health and these vulnerable populations would be the beginning of a much greater task.  For instance, many of the children lived in poverty-stricken areas with poor housing conditions, which exposed them to asthma triggers that often worsened their condition.  Most families were completely unaware that environmental factors, outdoor and indoor, could trigger an asthma attack.  Because of the knowledge-based perspective of research Dr. Claudio and the program experience provided, the other students and I were able to identify and provide solutions to problems.

The opportunity to work with these families and contribute to the overall improvement in the health of children with asthma in Harlem, New York, was an honor.  Further, this experience served as a stepping-stone for the continuation of my research in the area of childhood asthma and investigations into the health disparities among children diagnosed with asthma living in underserved rural areas of New Mexico and Arizona.

As a physician assistant for the last 14 years, I continue my commitment to working with vulnerable populations and providing medical care to those with the most need.  Although I mainly work in a family practice in a predominately Latino underserved community, during the past year I have been volunteering at various churches throughout Arizona to provide medical care for immigrant families seeking asylum.  Every day, over 100 detained families are dropped off at these churches by US Immigration and Customs Enforcement officials.  Many immigrants have been given no instructions on where to go or how to find relatives living in the US.  Others are dropped off at bus stops, leaving them homeless and helpless in an unfamiliar country without money, cell phones, or information on where to go.
As the daughter of immigrants, I am privileged and honored to be part of this group of volunteers providing humanitarian assistance to these individuals and I recently wrote about this experience in an article published by the American Academy of Physician Assistants.  I am also thankful that these churches have opened their doors and provided humanitarian assistance by allowing us to establish volunteer-run free clinics for these vulnerable immigrant families.  Many of our medications are donated, but too often supplies run short for treating even the most common illnesses.  Common conditions we frequently treat are upper respiratory infections, fevers, otitis media, fungal infections, and wound care.  Because of the scarce medical resources, I have raised funds to help purchase medications and other medical supplies.  In addition to bringing awareness to the current humanitarian situation with asylum-seeking immigrants, I have used social media to recruit medical volunteers.  The largest challenges in this humanitarian relief effort are the political and social determinants that have further complicated their access to medical care and continuity of care. 

As a physician assistant, the combination of delivering health care to patients and conducting research to identify factors that lead to health disparities and find solutions for those disparities is the most fulfilling and gratifying aspect of my career and is a way to better serve my patients.  We live in a world where there are many impoverished communities that lack access to medical care.  As a practicing physician assistant, I want to continue devoting my time to assist those who are most in need, and I hope that more physician assistants will be inspired to conduct research and develop effective educational interventions for underserved communities.

Over the last 22 years, I have been the director of training programs in which I mentor undergraduate, graduate and postgraduate students.  Mentoring and guiding students is my favorite thing to do at work.  I have served as mentor to hundreds of students over the years.   
Many college students ask me whether they should go to grad school.  I never answer that question.  It is a big decision for them to make.  I do tell them what they can expect in grad school that will be different from college.  This can help take some of the shock out of this transition and help students prepare for what's to come in graduate school, for those who decide to go that route. 
Here are 7 differences between the college and grad school experience:

1. You have to be self-motivated:  There's generally no "homework", quizzes, and few exams in grad school classes.  Some classes may only require a final paper or exam.  Although that may sound good to you, it is a major adjustment for college students. Because there is less interim feedback, some students find it difficult to gauge whether they are learning at the right pace in a course – until it is too late.  To succeed in grad school courses, you must find your own self-awareness of how much you are learning every day without the external pressure of frequent exams.
2. You must learn how to learn: Although some graduate courses may use textbooks, many also include original materials such as peer-reviewed articles as the main information sources.  To be able to extract the relevant knowledge from original research articles can be difficult for college students who may not be very familiar with this type of source.     
3. Learning from experts rather than teachers: Seminar-style courses can be tricky for students transitioning from college to graduate school.  These kinds of courses may have a course director who may teach a few of the lectures, but then schedules presenters who are experts in specific topics to give lectures as guest speakers.  Students need to adjust to this because the series of lectures and seminars can feel disjointed and discontinuous.  Another common difficulty that students face with this kind of course is that lecturers vary in their style and the presentations can vary in didactic value. It is up to you, the student, to piece it all together.  
4. Fewer classes per semester: I have reviewed some undergraduate transcripts that make your head spin.  There was the student who double-majored in Africana Studies and Fermentation Science, and the young woman who attempted to improve her low GPA in the sciences by taking credit classes in aerobic exercise.  You don’t get to do this in grad school.  In graduate school, you take fewer classes per semester and the classes are more focused towards training you with the knowledge and skills you need for your specific career.
5.  Digging deeper: Fewer classes doesn't mean more idle time.  In graduate school, classes tend to focus on more specialized topics, like anthropology or microbiology and get into the more intricate details of the theme.  If in college you did a flyby, in grad school you do a deep dive exploration.
6. One big huge project: Most graduate programs require a long-term scholarly project that students must complete before the degree is granted.  This can be a thesis, dissertation, scholarly paper, research project, etc.  Completing a dissertation requires a different kind of relationship with a professor.  The teacher becomes more like a mentor who guides the student through the process of inquiry.  The student then becomes more like an apprentice, working on some aspect of the mentor’s research.  Some college students never experience a mentor relationship until they get to graduate school and this can be a very difficult transition.  
7. A different kind of fun: The graduate experience can be very different (more subdued, less say...) than college life.  You will find that most students in grad school have a strong purpose to learn and less time to party.  It may not only be because the students are older, or that they are all nerds.  It is also because in grad school it is nearly impossible to cram for an exam the night before a test or to come hungover or sleepy to a graduate class or to a meeting with a thesis mentor.  The learning needed to succeed in grad school requires consistent discipline and self-directed study.  Although you can still have fun in grad school, the stakes are high and it is very difficult to get away with just a passing grade because you will need to acquire this knowledge for a job or a career.

The bottom line is, successful graduate students need to be motivated and driven from within.  It can be hard to transition into this model because students may be used to periodic assessments and short deadlines where they know how they are doing along the way.  In graduate school, a long time can pass before you realize that you are not learning all you need to learn or that you have not done all the work needed to complete a dissertation.  That is a rude awakening to have after years in grad school.

Graduate level education is certainly not right for everyone.  It is definitely not right for students who simply go to graduate school as a way to delay a career decision.  Graduate school is a huge investment in time and money, so students need to be aware of what to expect.  If you are not sure, work for a year or two and then decide and prepare for a very different school experience.  

An alumnus of Stanford University and the London School of Hygiene & Tropical Medicine, Amaya Caballero Wittmaack is now a 3rd-year medical student at the University of Virginia School of Medicine and Co-Founder of a data science company, A/B Data Doctors (www.abdatadoctors.com). She was a participant in the 2012 Mount Sinai International Exchange Program that I direct.  I placed her to do her internship at the Pediatric Environmental Health Specialty Unit in Murcia, Spain with my colleague Dr. Juan Antonio Ortega. This is the story of how a series of international experiences and the research training that we provided led her to go to medical school and start a data services company.  ​

My undergraduate adviser once said to me “it is not just what you do, it is how you do it.” She certainly applied these words to her own life as a proponent of equal rights, founder of the Global Fund for Women, and Nobel Peace Prize Nominee. Her advice helped me go from an 18-year-old idealistic college student to a forward-thinking 28-year-old medical student and business owner of a data science company.
I founded A/B Data Doctors with my husband in 2018 to provide data science expertise to individuals and organizations. We have worked with companies such as Zocdoc.Com, suitX, Skye Biologics, The Khana Group, and others around the world to leverage health-related data to support the design and implementation of evidence-based approaches to improving health interventions and access to healthcare resources. Currently, our organization also provides support to other sectors including private companies conducting market research, education-related organizations, and eHealth start-ups. Our services include data analysis, biostatistics, data visualizations, survey design and dissemination, study design and ethical approval support, and other data science needs.  Our long-term vision is to develop our own projects and proposals as well as apply the concept of leveraging healthcare data to improve health systems in the developing world.
My experiences thus far have taught me a few lessons.

• Firstly, you never know what opportunities life will throw your way—when they come, use the opportunity to strengthen yourself as much as possible and live out the experience to the fullest.
• Secondly, in retrospect, everything happens for a reason. It will all make sense later.
• Thirdly, remain open to learning from supervisors, mentors, and colleagues.
• Lastly, remember that “it is not just what you do, it is how you do it”.

I will tell you how I have learned these lessons.
My roots as an entrepreneur and healthcare worker began when I was a volunteer and non-profit worker. As a premedical student at Stanford University, I spent my free time volunteering with nonprofit organizations such as TeachAIDS, where I helped develop and disseminate HIV prevention education tutorials to youth in low income countries. When I graduated, I remained committed to participating in transformative initiatives, and I was interested in gaining more research experience. I learned about the Dr. Claudio’s International Exchange Program from a classmate at Stanford and decided to submit an application. A few weeks later, I learned that I was selected as a participant for the summer of 2012 in Spain. While at the time I had hoped to be assigned to a project in a low-income country, I later realized that my assignment was an ideal personal and professional development opportunity.
As a participant, I traveled to New York City to visit the School of Medicine at Mount Sinai for the program’s orientation. I met with other like-minded students, gained mentorship from Dr. Claudio and alumni of the program, and learned more about health disparities. Then, I flew to Murcia, Spain, where I began my summer research internship at the Hospital of the Virgin of Arrixaca working in the Pediatric Environmental Health Specialty Unit. My project focused on whether maternal breastfeeding habits predicted childhood obesity indicators. I shadowed clinicians, entered data from surveys, collected survey data using phone interviews, analyzed data using SPSS, and presented my results in a manuscript and presentation to my mentor. My experiences in Spain and the opportunity provided by the program shaped my career immediately following my time in Spain and to this day. Conducting research in an international context was invaluable both in developing my professional Spanish language skills and learning how to work in a cross-cultural environment. Having the opportunity to explore Spanish culture on the weekends, completing the famous “Camino de Santiago” pilgrimage, and spending three weeks following the completion of my project traveling around Europe enriched my worldview.
Immediately following the program, I was hired by USAID-funded nonprofit organization based in Washington D.C. that promoted family planning, community health, and gender-norm transformation interventions in India, Rwanda, Uganda, and Guatemala. Due to my hands-on experience conducting research in Spain, I pursued training in data analysis and qualitative research—fortunately, Georgetown University’s Institute for Reproductive Health had numerous individuals committed to teaching in these areas. Through this position, I saw the importance of leveraging data to appeal to stakeholders, to obtain funding for critical development programs, and to support initiatives that were both effective and cost-efficient. My passion for evidence-based healthcare continued to grow. Having loved my experiences in Europe, I ultimately decided to return one year later to pursue a master’s degree.
I pursued my MS in Epidemiology at the London School of Hygiene & Tropical Medicine to acquire skills in healthcare data analytics. Later, I applied to medical school and am currently finishing my third year as a medical student at the University of Virginia. As a medical student, I continued to pursue opportunities to serve my community. I became a community health organizer where I organized screening programs for homeless residents. I was appointed as the president of the International Medicine Club and promoted our mission to encourage our best and brightest to use their skills in regions with limited healthcare resources. Personally, I was awarded the Center for Global Health Scholars Award to do research and healthcare in a rural center in Tanzania. I also worked for two years doing clinical research, where I helped found my University’s first pregnancy cohort and traveled across the country presenting my research. During my third year of medical school, I founded A/B Data Doctors and am currently applying for the MD/MBA program at the Darden School of Business at the University of Virginia. I aspire to utilize my expertise as a future medical doctor, researcher, and entrepreneur to develop my business into an organization that leverages healthcare data to support initiatives that are both efficacious and cost-efficient. I aim to promote this mission both within the United States and also within developing regions.
So this is how I have learned these lessons, through making sense of these experiences to create my own story.  Firstly, you never know what opportunities life will throw your way—when they come, use the opportunity to strengthen yourself as much as possible and live out the experience to the fullest. Secondly, in retrospect, everything happens for a reason. I see now how being assigned to the project in Spain with Dr. Claudio’s International Exchange Program was the perfect experience for me, ultimately leading me to pursue other research opportunities, obtain my MS in the UK, become more involved in mitigating health disparities among Spanish-speaking patients, and most likely lead me to apply my skills in founding A/B Data Doctors. Thirdly, remain open to learning from supervisors, mentors, and colleagues—not only will their connections further your long-term goals, but learning from their experiences will enrich your own. Lastly, remember that “it is not just what you do, it is how you do it”—behaving professionally, with integrity, and being well-intentioned are essential aspects to being an inspirational leader. In my experience, adopting this philosophy has helped carve a professional and personal trajectory that excites me more and more as the days go by. 

I have been the director of several internship programs for more than 20 years now. I have reviewed thousands of applications from students at all academic levels.  What is striking to me is that I see the same mistakes year after year.  Different applicants, same mistakes. 
Here are three actions students should take when applying for internship programs.
1. QUALIFY- Read all qualification criteria carefully. Do not apply for internships for which you clearly do not qualify. If you are not sure if you qualify, read additional materials or contact the internship organizers. Applying to internships requires a lot of time and effort.  Don't waste your time if you do not fit ALL the criteria for acceptance into a program.  Rarely, if ever, do programs make exceptions to their entry criteria.  Here are some examples of entry criteria that applicants often try to sidestep or ignore:

• GPA- Many programs, such as those funded by the National Institutes of Health, require that interns have a grade point average of 3.0 or above.  This is non-negotiable.  Some programs even require a 3.0 GPA in the student's major, so trying to increase your GPA by taking irrelevant classes does not get you closer to being accepted into these programs.  If your GPA is lower than 3.0 and you want to qualify for these kinds of internship programs, consider receiving tutoring or repeating some courses in the summer and try again the following year.
• Start/End Dates- Summer programs can have firm start/end dates that do not necessarily fit with your school's schedule.  This is important because summer programs may require commitment to specific dates for important reasons such the need for interns to attend orientation, group training sessions, or a need for coordination with mentors' schedules.  Understandably, this is very frustrating for potential applicants whose home institutions require summer activities.  However, accepting a scholarship or internship, especially those that are paid or particularly competitive, require a commitment from participants.  Before applying, review your calendar and make sure that you can actually be available for the dates required in the internship program. If not, check with your school advisers to see if they can give you special permission to attend the internship, if you are accepted.  If so, get their agreement in writing.
• Previous Training Requirements- Some internships may require that you already have certain skills.  For example, if you are applying for a summer program on big data, do you need to have certain computer programming skills before attending?  If you don't have those skills yet, will you be enrolled in a course prior to the start of the program?  Are you likely to learn the skills required before the summer?  Be honest with yourself about your strengths and weaknesses. Misrepresenting or exaggerating your level of training can seriously backfire if you are accepted into a program and don't do well. Strive to enter internship programs that are challenging, but within reach for you based on your current training level.
• Socioeconomic Status Requirements- A few programs are intended to address issues of under-representation of individuals that are socioeconomically disadvantaged on the basis of race, ethnicity, income, gender, citizenship status or other criteria.  Some of these socioeconomic criteria may only require self-identification while others may require documentation such as tax returns or passport.  If you are in doubt as to whether you fit these kinds of criteria, you may want to contact the program organizers for clarification.  

2. VERIFY- Application forms for internship programs can be brief with only a few documents to submit, or extensive with requirements for essays, transcripts, letters of recommendation, etc.  If the application platform allows, preview all forms and documents needed before you start the application process.  This will allow you to estimate how much time it will take you to fill the application and verify what documents you may need to request or find before you start.  If the application requires letters of recommendation or documents that you need to get from other people, make those requests first. That way, those documents will be in process, while you work on the application forms.  No professor likes to get a call or email from a student requesting a letter of recommendation that is "due tomorrow"!  Let them know with plenty of time that you will need their letters by a certain deadline. 
Once you preview the application requirements, verify everything as follows:

• Verify That Your Responses Are Accurate- Make sure that all of your responses are accurate.  Some common questions in which I have seen students not be quite accurate in their application forms are current GPA, the courses completed, dates of previous experiences, names of awards, etc. Inaccurate or false statements may get you in the door, as a finalist for a program, but nowadays many programs use verification services to check the information that you provide.  You don't want to be the one that is caught in a lie, whether intentional or not.
• Check and Double-Check- Review your resume, responses, and essays for typos and grammar.  Don't only check for misspellings, but also for grammatical errors and accurate names. It helps to run your application through a grammar and spelling program before pasting it onto the application forms.  It can also help to read it out loud to yourself or ask a friend to check it for you.  It seems like a no-brainer, but I assure you it's not.  I have received applications in which students misspelled their own name.  I have received applications with sidebar comments or reminders that students intended to fix later, but forgot. And, my personal favorite error, applications directed to other programs.  Every year, I get a few applicants that talk about how much they want to enter the program at Columbia or Yale, which would be fine, except that they are applying to my program at Mount Sinai.  This happens because students cut/paste the same responses into different application forms.  It is fine if you do that, but please, verify before you apply. 
• Answer the Questions- Strive to be clear and direct in your responses.  Remember, selection committees are trying to find out whether you are likely to succeed in their program.  Make it easy for them to read and understand your responses. For example, if you are asked to write an essay detailing your career interests, then talk about YOUR career interests.  I have received many essays that read like a thesis on the subject with paragraph after paragraph on generalities about the topic of the internship.  They tell me things that I already know.  Instead, I want you to tell me why YOU are interested in this topic, what makes YOU good at this, what has been your experience in this area of work, and how you plan to pursue a career in this area in the future.  Tell me how this internship will help you achieve your goals, and what you will bring to the program.  Prove to me that you will succeed in the internship.  Provide evidence and examples.  Details like these make for a winning essay rather than one that sounds generic or like a page ripped out of any textbook.

3. APPLY- Once you have determined that you qualify and you have verified that all your information is accurate, do not hesitate to apply.  Don't be intimidated.  Don't run out of steam.  Although many internship programs are very competitive, you will not get 100% of the programs for which you don't apply.  Send your complete application forms and all documentation on time before the deadline and you will have a chance.

Our previous research has shown that exposure to contaminants in outdoor and  indoor air can affect respiratory health, especially in children.  This is important because diseases such as asthma, bronchitis and other conditions are very common and affect many families. 
We have also previously written about the discovery that houseplants could potentially improve the quality of indoor air by filtering some common pollutants.  Different kinds of plants may be able to absorb different kinds of pollutants from the air and from soil.
More recently, I was interviewed by Julia Ries for an article on Healthline.  The article is about a recent study by researchers from the University of Washington in which they show that genetically-modified pothos ivy can absorb benzene and chloroform from the air.  For the article, I was quoted as follows:
   “Air pollution is a major contributing factor in diseases, including cardiovascular disease, respiratory diseases such as asthma, and potentially brain development in children,” said Luz Claudio, PhD, a tenured professor of environmental medicine and public health at the Mount Sinai School of Medicine in New York City.
“We have better control of the environment inside our homes, so it’s worth having clean air indoors as much as possible,” Claudio said.
The original scientific article from the laboratory of Dr. Stuart E. Strand was published in the journal Environmental Science and Technology and can be found HERE.  In their study, the Strand team showed that introducing a detoxifying gene that is normally expressed in mammals (a cytochrome called P450 2e1) into pothos ivy plants not only made the plant express the gene, but also made the plant able to detoxify benzene and chloroform from the air. 
Although this type of research holds promise as a way to improve our environment, genetically-modifying plants is a controversial approach.   We don't know if adding or modifying a gene in an organism can affect other properties beyond the characteristic intended for modification.  In spite of those concerns, genetic engineering holds immense promise as part of the arsenal of approaches towards improving environmental health.  

Global environmental health is recognized as the most pressing challenge of our time. A recent report by The Lancet estimated that environmental pollution causes three times more deaths from non-communicable diseases than AIDS, tuberculosis and malaria combined, and that 92% of pollution-related deaths and diseases occur in low and middle income countries.  Yet, there are few opportunities for the scientific research workforce is receive training in this area of work.
 
I have been the director of the Mount Sinai Division of International Health since 2004.   Our mission is to partner with scientists in other countries to enhance capacity to identify, document, prevent and mitigate environmental health problems that have the potential to affect morbidity in vulnerable populations, especially children. To do this, we initially trained and nurtured the careers of 52 international scholars in Mexico, Brazil and Chile through the Fogarty-supported ITREOH Program - International Training in Research in Environmental & Occupational Health.  We have now expanded our collaborations to 5 additional countries: Argentina, Costa Rica, Spain, South Africa, and Ireland.

My collaborations have developed into close friendships with many international scholars.  Now, after so many years, we have collaborated on many research projects and joined forces to mentor a new generation of researchers.  Through funding from the National Institute for Minority Health and Health Disparities, my former international fellows and I have provided research training to 140 minority students from the US.  Every year, we select 10 students from a national pool of hundreds of amazing applicants, bring them to New York for an intense orientation period and match them with international mentors.  The students then spend 11 weeks conducting research in those countries.  Upon their return to the US, the students continue to receive support to complete research reports worthy of publication.  An astounding number of students, about a third, publish their research in peer-reviewed journals, while others have their manuscripts at different stages of review.   Yet others, present their work at international professional conferences and receive recognition for their work through awards, fellowships, and acceptance to other prestigious programs.

Features of our International Exchange Program that have made it so successful over the last 15 years are:

• Multi-tiered selection process- students are not only selected based on their academic achievements, but also potential demonstrated through perseverance, interests, enthusiasm, and other abilities.  An experienced selection committee that includes alumni of the program reviews the applications and conducts in-depth interviews in order to select the right participants for the program.
• Thorough pre-travel training - Selected students participate in an intense training program prior to being deployed to their international sites.  The training includes an introduction to scientific writing based on the book: How to Write and Publish a Scientific Paper: The Step-by-Step Guide.  This greatly clarifies expectations and provides selected students the tools they need to succeed in the program. 
• Close relationship with mentors - careful matching of student-mentor pairs is possible because of our familiarity with mentors' research projects, relevant skills, and training environment at the host institutions.  
• Quality of the applicant pool - Minority students from all over the US compete for the 10 positions available.  This results in a diverse applicant pool and increases the opportunity to select the best student-mentor pairs.  Given the high level of interest in this program, we would like to expand the number of positions and add a broader international mentor training program.
• Continued long-term mentoring- ​We are available for consultation and mentoring to all students who have participated in the program over the years.  We also support and encourage peer-to-peer mentoring between alumni of the various programs.  Many alumni of the program are now in high-level academic positions and serve as inspiration to current students.

This program has been one of the most satisfying experiences of my career.  I hear students say that the experience of conducting mentored research abroad changed their lives.  It fills me with pride to see students from this program achieve amazing things.  Some are doing important work at the United Nations, National Academies of Sciences, Departments of Health, and other prestigious institutions.  Some alumni are doctors and scientists at hospitals and medical centers, others are caring for people in the poorest corners of the world.  Some are training other students at medical schools, others have started their own businesses.  I like to hear from them all.  It brightens my day to open an email from a former student or to get a card in the mail.  Alumni tell me about their successes, they seek advice, they tell me about their experiences trying to get to their next level.  It is a thrill and a joy to hear their stories, some I have published as Guest Blog Posts.   
I think this program has opened their eyes to a world of possibilities, literally.  It is worthwhile. 

Valencia Lyle was a fellow in both my Short-term Training Program and also in my International Exchange Program, during which she reaffirmed her love for working with underserved populations in other countries.  Through a series of deployments in Tanzania, South Africa and Uganda, Valencia has gained a broad range of amazing experiences that illustrate how to piece together a career in global health by following 5 steps.  Here is Valencia's story in her own words.  

​A well-recognized tradition in U.S. elementary, middle, and high schools following students’ completion of each major educational milestone is for students to write letters to their “future selves.”
 
I intermittently revisit these letters to informally tally the instances in which my career goals drastically evolved. My middle school letter to myself demanded that, by the age 25, I be married, have two children, and work as a pediatrician at a hospital in Michigan.
 
Now, five years past my deadline for accomplishing these major life events, it’s clear that I have abandoned them – at least for now. There were two major work and learning opportunities that led to a major shift in my career goals: my Peace Corps service and the Mount Sinai School of Medicine International Exchange program.  These experiences solidified my ambitions in pursuing a career in global health.
 
In recognition of my long, arduous journey to feeling comfortable describing myself as a global health practitioner, I would like to pass down some of my lessons learned to my fellow young professionals aspiring to work in the field of global health outside of their countries of residence.
 
1.    Take a step out of your comfort zone 
In October 2011, I embarked on my first global health experience as a Peace Corps Volunteer in Tanzania. I was placed in a small, rural village situated within the picturesque Livingstone mountains of the Southern Highlands of Tanzania.  With this being the first time I not only lived out of state, but lived out of the country- unaccompanied- I faced an everyday battle between “toughing it out” and returning to the familiarity and comfort of the place I called home for the first 21 years of my life.
 
Despite the aforementioned inconveniences, Peace Corps was one of the most amazing work experiences I have ever obtained. Developing strong bonds with a community in an unfamiliar culture, mastering a new language, and working with diverse community leaders to find solutions to issues plaguing the residents of our village was rewarding beyond belief. 
 
I ultimately decided to move forward with option number one: toughing it out. This afforded me extensive work experiences in supplying antiretroviral therapies to adults and children living with HIV and ensuring these populations had access to care.  My Peace Corps service served as a catalyst for my interest in pursuing a career in public health which is why, following the close of my Peace Corps service, I pursued a master’s degree in public health from Columbia University’s Mailman School of Public Health.
 
 2.    Don’t endure the journey alone – seek mentorship 
During my graduate studies at Columbia University, I vacillated between building a career in the U.S. and working abroad. It was not until I joined the 2015 cohort of the Mount Sinai School of Medicine International Exchange program that I realized I did not want to start my global health career off in the U.S.
 
While a participant of the Mount Sinai School of Medicine International Exchange program, I was fortunate to receive two mentors: Dr. Luz Claudio, who assisted me in identifying a potential career trajectory in global health, and Professor Rodney Ehrlich, my research mentor at the University of Cape Town (UCT) in South Africa. Under Professor Ehrlich’s supervision, we conducted a study assessing the incidence of tuberculosis in South African gold miners. We aspired to use the results of our study to strengthen occupational health guidelines in gold mining companies and policies in South Africa.
 
The research I conducted at UCT and my overall experience in the International Exchange Program elicited two major revelations about my career trajectory: 1) if I conduct research, it should be research that will propel data driven policy making, and 2) I enjoy careers in which there is a combination of program implementation and research.

3.    Explore different professions in global health through internships, fellowships, and short term positions 
The critical revelation about my ideal working environment that I acquired from completing the Mount Sinai School of Medicine International Exchange Program incited my eagerness to explore the wide range of professional opportunities within the field of global health. This led me to acquiring internships and short term positions in an assortment of areas in global health and policy ranging from marketing writing at the Clinton Global Initiative to policy research at UN Women during my graduate studies at Columbia University. 
 
Immediately after obtaining my MPH, I received an opportunity to manage a fresh food voucher program for South Sudanese refugees in Uganda. While I feel privileged to have received the unique and humbling opportunity to work in refugee settlements in a high impact area – nutrition, the position opened my eyes to the necessity of research in this field. I began to grow interested in assessing the cost-effectiveness of various nutrition programs, discovering innovative ways to build the capacity of the health workers and various stakeholders we trained, and investigating the manners in which diverse health policies affected the outcomes of the programs we implemented.

4.    Once you think you have everything figured out, embark on a purposeful career search 
The professional revelation I acquired from working in Uganda resulted in me scouting out a work experience that combined both of my passions – program implementation and research. I began supporting the Rwanda Ministry of Health as a Monitoring, Evaluation, and Research Officer through the Global Health Corps. This position offered me experience in both supporting the implementation of programs at the national level and conducting research to further support data driven decision making.
 
This position was such a great fit that even after the end of my Global Health Corps fellowship, I have continued supporting the Rwanda Ministry of Health as a consultant. From conducting research on surgical outcomes to assessing the implementation of civil registration and vital statistics procedures, my work at the Rwanda Ministry of Health has challenged me to think outside the box with regard to program implementation and strengthened my ability to conduct health services research under the mentorship of well-established experts in health service delivery, research, and policy making.

5.    Take your time – don’t let anyone rush you into zeroing in on a career path you are not certain you would like to pursue 
While I am acquiring my short term career aspirations, I am still far from obtaining the work experiences and educational credentials needed to fulfill my long term career aspirations.
 
Although I had a path to success spelled out for myself by the age of 12, I decided to deviate from that path through taking my time and exploring career opportunities outside of medicine. Exploring careers outside of medicine was the best decision I could have made for myself as working in global health has empowered me to collaborate with global health experts around the world to improve the health and well-being of populations both in the U.S. and abroad.
 
As a young professional, I know that there is so much pressure for us to have it all figured out by the time we graduate from college. I am taking my time to explore the different professional opportunities in global health and I will admit that I still have not figured everything out. My advice to you, my fellow young professionals, is to take your time and do not settle on a career that seems comfortable, easy to obtain, and familiar. Whenever I begin to doubt my decision to take my time and explore different careers, I call to mind a quote from Steve Jobs: “the only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle.”

Follow Valencia Lyle in Medium or LinkedIn

As part of our monthly series of guest post, I present to you Nathalie Fuentes. A student from my hometown of Caguas, Puerto Rico, Nathalie is currently pursuing her PhD at Penn State College of Medicine. She was selected from among over 400 applicants to me International Exchange Program for Minority Students. Nathalie reminds me so much of my younger self in her projection of confidence while battling internal insecurities and impostor syndrome. Here she is in her own words.
I was born and raised in Caguas, the heart of Puerto Rico, to humble parents. I was always interested in science. Starting at the age of 5 with my first project presentation at a science fair, my curiosity and urge to know and understand the human body led me to study its function, and the factors that can affect human health. During high school and thanks to the help of a wonderful teacher, Mrs. Lourdes Hernández, I began to visit research laboratories located in the Medical Sciences Campus of the University of Puerto Rico, where I knocked countless doors. While many scientists told me “No”, my patience and perseverance paid off when one researcher, Dr. Carmen L. Cadilla, said “Yes”. Then, at 15 years old, I was selected by Dr. Cadilla as an intern in her NIH-funded Short-term Research Experience for Underrepresented Persons (STEP-UP) I received funding from the National Institutes of Health (NIH) Short-Term Research Experience for Underrepresented Persons (STEP-UP) Program to support my participation in six summer internships.
Despite many accomplishments and the skills and knowledge I have sought out and acquired, my journey as an undergraduate student was not easy. I started my undergraduate studies in Chemistry at the University of Puerto Rico. During my sophomore year, I decided to transfer to a Biochemistry program at Iowa State University. It was clear that this change would bring many challenges, but I did not know all the consequences and responsibilities that would come with this decision. My family had very little financial resources, and to help overcome some costs, I had to work as a research assistant during the day and as a tutor during the night. In addition, I never expected that the English language would be such a hard obstacle for me. I clearly remember how during my first oral presentation, a student asked me if I was truly speaking English because it was incomprehensible. Even though I felt my world crumbling, I used that as motivation to raise my GPA and conquer my dream of becoming a scientist.
Throughout my journey as a student in the United States, I also faced many of the challenges associated with being an underrepresented minority woman in science. However, I always searched, found and created my own opportunities to accomplish my goals by becoming a well-trained and versatile researcher. As an undergraduate student, I was able to explore and conduct research in different scientific topics. For example, during a summer internship at Pennsylvania State University, I studied signal transduction pathways that control tumor suppression, gene expression and chromatin remodeling in leukemia. As an Iowa State McNair scholar, my research about methanotrophic bacteria led to a publication in the Journal of Inorganic Biochemistry. Also, during this time, I obtained independent funding to join a scientific team at Harvard University, where I investigated the role of retinal ganglion cells with the end-goal of developing novel treatment for optic nerve degenerative diseases. Soon after I completed my undergraduate studies in Biochemistry and Linguistics, and had the opportunity to be selected as a fellow of the 2015 Mount Sinai International Exchange Program for Minority Students. This prestigious program allowed me to conduct research at the University Federal of Rio de Janeiro in Brazil, working on genetic engineering microorganisms for bioremediation.
I always knew that graduate school was my next step. The application process was nerve-wracking. I never felt 100% confident that I was going to get into my dream school. During my first interview, I felt so anxious, to the point where I just cried because of how stressed I was. After 5 interviews and 5 acceptance letters, I decided to join the Biomedical Sciences Program at Penn State College of Medicine. I based my decision on the school ranking, type and quality of research, location and mentors with funding available.
My first years as a graduate student were tough. I remember walking through the doors of Penn State College of Medicine with a lot of enthusiasm, bright-eyed and driven to excel in my graduate studies. I felt unstoppable, without knowing that in a matter of days everything was about to change. Feelings of insecurity started to arise. I was feeling suffocated with that pressure of being obligated to excel. For the first time in years of an exciting scientific career, I was feeling like an impostor. I did not know what to do, until I discovered that the key was to find the right mentor. I joined Dr. Patricia Silveyra’s lab, which focuses on respiratory disease. The reason why I chose to study lung disease was because my grandfather, the man who helped raise me, died of a pulmonary disease. I decided at that moment to think outside the box and explore molecular processes that govern the functioning of lung disorders. Dr. Silveyra’s guidance gave me the support that I needed to not only overcome these obstacles, recognizing the existence of “impostor syndrome” and strategies to overcome it, but also to become a well-trained scientist, a leader in the community, and a role model for future scientists.
My main scientific goal now is to understand the immunological basis of the sex differences observed in asthma exacerbation triggered by air pollution. In almost four years of work, I have made significant progress in my experimental work, as well as in career development. I have published two papers as first author, and submitted two additional ones. I have contributed to several other manuscripts, review articles, and book chapters from the lab. I have been recognized with local, national, and international awards. Most importantly, I have focused on mentoring underrepresented students interested in science. Training and working with people from diverse backgrounds is an adventure. Science benefits from diversity! It amazes me how different perspectives can contribute to produce better research.
What have I learned from this journey? First, besides all the knowledge acquired, I have found role models that motivated me, taught me to uncover my true potential and overcame my barriers. Mentors provide knowledge and can see where we need to improve. They always find ways to stimulate our personal and professional growth. My advice to students starting their journey is this: Find someone who you admire and respect, and who has a career path similar to the one you aim to follow. Also, we naturally have the predisposition to get trapped on the negative and think about our failures, instead of counting our victories. Initiative and motivation are indispensable. Successful students not only have brilliant ideas but they take initiative and carry them forward. If you need help, ask. If you have questions, ask. Don’t be afraid! Obstacles are inevitable, but successful people never give up.

Ask your grandmother when she hit puberty. Then ask your mother.  Ask other women in your family.  Do you notice a pattern?

Yes.   In recent years, girls have been developing at younger ages.  Today, it is not uncommon to see middle school girls who look like grown women.  But why?

Some investigators point to obesity as part of the explanation for this trend.  Although that is far from conclusive, it seems to be an important factor.  However, we also suspect that exposure to some chemicals in the environment may contribute to earlier puberty in girls.  

I was part of a team led by Mary Wolff, PhD, that investigated the relationship between exposure to chemicals found in personal care products and signs of puberty in a group of African-American and Latina girls.  In that study, we recruited girls at 6-8 years of age and followed them over time, assessing their exposure to chemicals, their BMI, diet, and puberty development.

A new study published by Dr. Brenda Eskenazi's team assessed whether exposure to these chemicals before birth could also lead to changes in puberty in children.  Their study found that exposure to chemicals commonly found in personal care products may cause early signs of puberty in girls, but not in boys.  The chemicals that they measured in this new study were phthalates, parabens and triclosan.  

I was asked by journalist Lisa Rapaport to comment on this new study for Reuters, the news organization.  Here is my quote:  “The effects of these chemicals are very complex,” said Dr. Luz Claudio of the Icahn School of Medicine at Mount Sinai in New York City.  “Their effects on the hormonal system is different with different chemicals, they have different potencies, their effects can be modulated by other factors such as genetic predisposition, and importantly, their effects can be different depending on the timing of the exposure,” Claudio, who wasn’t involved in the study, said by email. “With that said, this and other studies, together with the laboratory experimental evidence point to potential effects on children.”

It is possible that only very few of you have heard that the US Global Change Research Program issued an important report titled: Fourth National Climate Assessment, Vol II. The report was released the day after Thanksgiving, so I don't blame you if you didn't see it. You were probably laying on the couch, belly full of turkey. Or perhaps you were at the mall, fighting the Black Friday crowds. So, since maybe not too many people saw it, I wanted to give YOU a chance to know about this. I am sending this to you because I am your friend.
Unlike the recent UN Intergovernmental Panel on Climate Change, this new report focuses on the effects of climate change on the US.
Here are some key takeaways:

1. If you ever thought that climate change would really just affect other countries far away, like Bangladesh or the Maldives, think again. Climate change is HERE.
2. If you ever thought that climate change is something that may happen in the future, like in the year 2100, when you will probably be dead anyway, think again. Climate change is happening NOW.

Consider that this report was not issued by some fringe, fear-mongering, doomsday group trying to sell you an underground bunker. It was issued by experts from 13 US government agencies, including NASA and NIH.

Divided in 29 chapters, it summarizes effects on communities, the economy, health, water, ecosystems, agriculture, infrastructure, oceans and coasts, air quality, tourism... Basically, every aspect of life in the US will be (or is) affected. The report also presents the expected effects by region of the US. Check out your region if you want to see a crystal ball into your (near) future.
In my view, the most interesting chapters are the two chapters on Reducing Risks through Adaptation and Emissions Mitigation.
In short:
   "Communities, governments, and businesses are working to reduce risks from and costs associated with climate change by taking action to lower greenhouse gas emissions and implement adaptation strategies. While mitigation and adaptation efforts have expanded substantially in the last four years, they do not yet approach the scale considered necessary to avoid substantial damages to the economy, environment, and human health over the coming decades."
In my interpretation, the report basically emphasizes mitigation and adaptation actions LOCALLY (state, cities, private sector), rather than (or maybe in addition to) at the federal or global levels. I wonder why...

​It states:
   "Mitigation and adaptation actions also present opportunities for additional benefits that are often more immediate and localized, such as improving local air quality and economies through investments in infrastructure."

Yes. Sure. It would be good to act locally to mitigate and adapt to the expected effects of climate change. Sure, let's plant more trees in New York. Let's shut down more power plants. Sure. Would these local actions result in measurable benefits at the global level? Only if many, many places do the same.

Do we really think that we will be OK as California burns, Venice disappears into the ocean, and tropical storms flood the east coast? No. It is all interconnected. As the report says:
   "Extreme weather and climate-related impacts on one system can result in increased risks or failures in other critical systems, including water resources, food production and distribution, energy and transportation, public health, international trade, and national security."

Believe or don't believe. Either way, take the time to understand what is happening. Do what you can to help mitigate and adapt.     

Dr. Luz Claudio is an environmental health scientist and author of the book: How to Write and Publish a Scientific Paper: The Step-by-Step Guide. She blogs about life in academia, and environmental health news. Opinions expressed on this blog are solely her own and may not reflect the opinions of her employer or colleagues.