From Nurse, to Brain Tumor Patient, to the National Academies by Carla Alvarado, MPH, PhD

Guest Blog Post: Dr. Carla Alvarado was one of my interns in the International Training Program for Minority Students some years ago.  Although I try to keep in touch with alumni of my programs, it is sometimes hard to keep track of where all of them are.  Imagine my delight when I went to a meeting of the Roundtable on Environmental Health Sciences, Research, and Medicine at the National Academy of Sciences,of which I am a member and saw that the only other Latina face in the room was that of my former student, Carla Alvarado, who is a superb program officer there.  I am extremely proud of Carla, who after overcoming incredible odds, has risen to such a great career that brings together so many of her diverse personal and professional experiences.
Here is Carla's story in her own words. ​

Looking back at my growing up in the US-Mexico border, I feel fortunate that I have a bicultural and bilingual culture. I can say now that growing up in a predominantly Hispanic community did not prepare me for life as a “minority” once I stepped out of the Southwest. But I believe that life had a way of having me experience everything I need to in order to land exactly where I need to be. 


Seeing the Health Care System as a Nurse in a Minority Community
Fortune continued to follow me as I graduated from a high school that was a magnet school for health professions, where I pursued a practical nursing degree. I earned a Bachelor’s in political science with a minor in economics, a master’s in public health with a focus on management, policy and community health, and international health. Then I worked for a local health department in Texas before pursuing a doctoral degree in public health policy. After all these twists and turns, I am currently a program officer at the National Academies of Sciences, Engineering, and Medicine in the Roundtable on Population Health Improvement. 


During my nursing clinical rounds, I observed many patients in precarious conditions, both in terms of the state of their health and in their living conditions. I saw patients with multiple diseases, and I noticed that those without health insurance were treated differently and released as soon as possible and often, within days, you would see them back again at the hospital.  Being in a region where 30% percent of the population was medically uninsured, I witnessed the impact lack of access to healthcare could have on people’s lives. I will never forget how people diagnosed with stage IV cancer were being sent home to die because they didn’t have health insurance and they were not eligible candidates for cancer trials. I saw families that were put under severe stress because of the financial strain of hospitalization.  I started questioning the fairness of the health insurance system or lack thereof. 


Seeing the Health Care System as a Brain Tumor Patient
As fate would have it, I lived first-hand the need for health care.  A few weeks after I graduated from the nursing program, I was diagnosed with a brain tumor and I had to undergo surgery. The surgery and the 2-year treatment that followed made me realize how lucky it was that I had health insurance that would cover the majority of the expenses, to this day I do not know how my parents were able to cope with the out of pocket expenses (nor will they tell me).


After being a patient and interfacing with the good, the bad and the ugly of the health care system, I needed to understand why the U.S. health care system was the way it was. I decided to study political science (to my parents’ dismay), and was subsequently dissuaded from a philosophy minor (because they said I’d starve) and encouraged to purse economics, which I did (but as a minor). As I completed my bachelor’s degree, I didn’t know what exactly I wanted to do after college, I knew I wanted (and needed) a master’s degree, but in what? One night, after going dancing I was venting to a friend about not knowing my next step, and she told me about her friend pursuing a master’s degree in public health, which embarrassingly I knew nothing about (I know, not even as a former nurse). To my delight, public health married all three streams of knowledge I had attained throughout the years, and so I applied to grad schools for an MPH program. 


Putting it All Together
During my MPH I had a variety of experiences that (in hindsight) made me a well- rounded public health student: I was involved in environmental health research, health disparities research, as well as policy and international research. It was tough being involved in so many projects, but I loved not only learning about the different sub-disciplines in public health but also having hands-on experience. So hands on, that as a student I was approached to become a consultant for a binational entity to conduct HIV-related qualitative research.  Upon graduation, I secured a job at a local health department in Texas where, in the span of 3 years, I held 3 different positions: I was a health educator, a public health preparedness community liaison and a de facto special projects coordinator. During the H1N1 response (ten years ago!) I was the crisis and emergency risk communications lead and the preparedness community liaison, and let’s just say that the experience left me wondering how the federal and state governments made their policy decisions and why they were implemented the way they were. The experience was the push I needed to decide to pursue a PhD in public health policy. I always knew I wanted a PhD, as a personal exercise of intellectual endurance, and the experience at the health department helped me refine the topic I wanted to commit to for the next several years. Pursuing a PhD was the most gratifying experience I have had, it was a challenge and it was taxing, but I’d do it again in a heartbeat. 


I wish someone would have told me to relax. Honestly. I wish someone had told me that yes, although it is important to be methodical about pursuing a degree (or several), the degrees give you (in the eyes of society as we know it) much more flexibility than people know. For example, I see people who graduated with a degree in public health who now work at the Department of Justice, friends who graduated with an urban planning degree working in public health, and other sorts of arrangements. I wish someone had told me that interdisciplinary experiences are also valuable and valued, being a generalist is also an area of expertise in public health. I wish someone would have mentioned that knowing about political science, economics, ethics, nursing, and public health would render a worthwhile portfolio of expertise, to hush all the people who pressured students to pick one thing and one thing only. 


The path to the National Academies makes sense to me in hindsight.  For starters, I graduated obtained a practical nursing degree in high school because my mother is a nurse and I thought that being a nurse was a pathway to becoming a doctor, as many of us children of immigrants are *encouraged* to become (note the euphemism). 
I am very fortunate to have found a job that allows me to apply the knowledge and multitude of experiences to the various projects we work on and even affords me the ability to keep learning about the maturing field of population health.
 
Some of the biggest obstacles that I have faced have been of the interpersonal kind.  Interacting with people who are not open to someone with a different background can be challenging.  But overall, it has been an asset to be a bilingual (Spanish and English) Hispanic woman, with experience in the clinical field, the research and practice-based public health field, and in health services research.  I can navigate in and out of many different areas, both professionally and personally. However, the ability to navigate different terrains means I have had to make in-roads into each, and that takes work and patience because you have to establish and exercise your agency. There have been many times, both professionally and personally, when any of the social categories  I am part of has been used against me. No need to exemplify such unpleasantries, but (sadly) it took me a long time to learn that those who use them against you are taking out their frustrations, ignorance, bigotry, and inferiority complexes on you, as opposed to there being something wrong with being any of the categories you represent.
 
I love learning and traveling.  Internships, especially those like the Mount Sinai Training Programs directed by Dr. Claudio, are so dear and near to me because they are professionally and personally intense, challenging, and rewarding all at the same time.  Those internship experiences helped me put my career together.  


The National Academies is a great place to work for people like me, it is a learning incubator if you will.  I am given liberty to pursue intellectual and professional endeavors that are aligned with our mission. There are days where I am at professional conferences attending or chairing a session, there are others where I spend most of the day reading familiarizing myself with a new topic because we are organizing a workshop, yet other days involve providing technical assistance to our innovation collaboratives, supporting the roundtable, writing proceedings, doing research for one of our reports, etc., etc. I especially enjoy the range of activities I get to carry out. No week is the same, and that is very helpful in terms of the quality of life within the workplace. I am truly honored and thankful that I have a job where I get to interface with so many of the great experts in public and population health. I get to nerd out and learn something new every week, meeting and interacting with experts from around the nation and learn about their work.  I do however miss data analysis, but that I can do as an extracurricular professional exercise.


I was once told that degrees do not mean anything, this was coming from a much older coworker at the health department who had been trained on the job and been working longer than I had been alive.   To which I said, “maybe you should tell your daughter that, isn’t she the first one in your family to obtain a college degree and is now pursuing a master’s degree?” Back then I didn’t realize that out of almost 400 employees, only 5 of us had a master’s in public health, including the Director and the epidemiologist, and I was the youngest, the amount of work and responsibility was too much too soon in most people’s eyes and so they would hit below the belt. At the time I was distraught and confused about their animosity, but now all I can do is be thankful that my degrees have opened doors to a breadth of experiences that I never knew existed, and that they still do not, or ever will. 
​