I am Roberto F. Refeca, born in Habana, Cuba, on September 30, 1973, to Olga and Roberto J. Refeca.  I am a college graduate with an MBA from the University of Miami, Miami, Florida and a Bachelor’s of Science (Biology, Chemistry) from Maryville University, St. Louis, Missouri.  I am a husband to Amy M. Refeca, and father to Sophia C. Refeca and Sammy Refeca.  Lastly, Currently I’m working in the field of Regulatory Affairs. I’m the Director, Regulatory Affairs at Clinical Genomics, Inc., a company focused on the early detection of Colorectal Cancer (CRC). 
I should explain this now, as it can get very confusing for those that are not familiar with the term Regulatory Affairs.  For a company to place a medical device on the market and make it available for sale to the public, they must meet the requirements set forth by the US FDA.  The US-FDA regulates products according to the risk/potential risks that they may pose to the user, the risks are largely based on the intended use of the product and the functional attributes and characteristics of the product.  The core responsibility for the regulatory professional is to guide companies through this process.  Once the product is on the market/distributed, the RA professional also helps companies by interacting with the Regulatory Bodies to maintain the registrations current.  Often times the roles for RA professionals within organizations can vary by also including responsibilities for post market surveillance, labeling, and more.  I hope that provides some color to my role/profession. 
What defines you? 
My experiences and my environment define me.  I’m an immigrant to the United States, arrived in 1980.  A childhood in a lower middle-class environment in St. Louis, Missouri, with friends that took every opportunity to play sports and go fishing.  I had many nights of searching our area for lighted spaces where we could play stick ball and basketball, or head to a fishing spot (creeks, lakes, rivers).  It was not uncommon for my friends and I to sneak into gymnasiums after hours and on weekends to play basketball during the St. Louis Winters.  The fever for sports and fishing started early for me, participating in baseball in middle, high school, and college.  The love for the study of Biology came later and was fostered in high school by a couple great mentors Mr. Don McLain and a Mr. Charles Shepperd.  Once high school was completed, fast forward through a couple years of undergraduate study (Barry University, Miami, Florida, and then Florissant Valley Community College, St. Louis, Missouri) and then I found myself at Maryville University majoring in Biology with a Minor in Chemistry.  To gain additional experience in science, I started volunteering at the Center for the Study of Nervous System Injury (CSNI), Washington University School of Medicine, St. Louis, Missouri, with John W. McDonald MD, Ph.D., during my junior year at Maryville.  John’s research interests were focused on mechanisms of oligodendrocyte death, specifically spinal cord injury.  While working with Dr. McDonald, it was not uncommon to find ourselves in the lab at 1-3am in the morning on the weekends and during the summer. 
In sports, there is god-given talent, and then there is that grind that happens when you work and you know that putting in that extra effort will often yield a positive outcome.  I saw this in John, a relentless pursuit with passion for the work that he was doing.  It became familiar for me to see this type of behavior that I was so used to being a part of in sports….I was applying it to my love for biology/science, and I saw others with the common approach. 
Dr. McDonald invited me the Fall of 1997 to a conference in New Orleans, Louisiana, right around the Halloween time of year.  It was here where I had my chanced encounter with a Luz Claudio, Ph.D., if I recall correctly it was during the lunch period when everyone was taking breaks from the conference when we met.   As part of our brief conversation Dr. Claudio welcomed me to apply to her summer internship program. I was awarded the opportunity to participate in the program that summer in 1998, in Dr. Luz’s lab at the Environmental Health Sciences Center, Mt. Sinai School of Medicine, New York, New York.  My work included trying to establish a cell culture model of the blood brain barrier using astrocytes and HUVEC (Human umbilical vein endothelial cells). 
After that summer I ended up in Miami, Florida.  After working as a baseball instructor at Red Berry’s baseball academy, I then started my professional working career (after being a college graduate) working at the Diabetes Research Institute (DRI), University of Miami School of Medicine.  The work was amazing, I was a part of the Human Islet Transplant team. In short, the program leaders were Camillo Ricordi, MD, Norma Kenyon, Ph.D., and Rodolfo Alejandro, MD.  Our focus was finding a cure for Type I diabetes via the transplantation of islets, the insulin producing cells within the pancreas.  My job was to isolate islets for transplant and for research from cadaver pancreas, it was not uncommon for the harvesting procedure to take 4-12 hours in the lab.  As part of the DRI program I was also able to experience technology related to the processing and harvesting whole bone marrow for transplant from cadaver bone marrow, and living donor iliac crest aspirates.  The science that was happening at the DRI was second to none, and I enjoyed every part of it. 
After working in science/the lab for a number of years at the DRI, I had thoughts of graduate school/focus on science.  It was always my dream to drive research to a clinical benefit in people.  I also started to yearn for a different challenge within science that would include more interaction in non-lab settings, getting closer to the interphase between research and clinical practice.  That lead me to my decision to pursue an MBA at the University of Miami, Miami, Florida.  After I finished the MBA program, I then took a job with Cordis Neurovascular in Miami, Florida which was a division of Johnson & Johnson.  It made more sense than what I knew at the time. 
 
How did you decide on this career path? 
This is a great question, I have not met a person yet in my career that by design ended up in the field of Regulatory Affairs (I’m sure that they are out there), most persons including myself end up in Regulatory Affairs in a “sideways” type of manner in that there are not many college programs that offer RA degrees.  I have had colleagues with undergraduate training in: science, engineering, communications, and graduate degrees such as MBA, MSc., Ph.D., JD.
What you like, don't like?
 What I love about my current role and the field of Regulatory Affairs.  It is very broad: I’m at the forefront of a technology/science in bringing new things to market and it also requires me to communicate effectively with a broad group of persons/groups within my organization.  Regulatory Affairs also requires me to communicate effectively with persons outside of my organization which can be customers to the business and regulators globally.  It is common for me to have routine conversations with: sales, marketing, operations/manufacturing, research & development, legal, and finance/accounting.   
In my various roles I have interacted with a very diverse group of professionals in all of the global markets, the professional relationships that I still keep today are priceless.  And because my roles have been global in nature, I’ve had the chance to interact with regulators from around the world including: Canada, EU-Notified Bodies, Mexico, Costa Rica, Australia, and of course our US-FDA.  In today’s world, business is global and regulatory is a key partner to any company’s global success whether it be the introduction of new products or maintaining products in existing markets.   
 
What do you wish you had known before you embarked in your career? 
In hind sight, I sometimes wonder what it would have been like to have started earlier in the field of Regulatory Affairs….but that is only a brief thought, I enjoyed my time in research too much: Washington University School of Medicine (Study of Nervous System Injury); Mount Sinai School of Medicine, New York (Environmental Health Sciences Center); and the University of Miami, School of Medicine (Diabetes Research Institute), Miami, Florida.  The places, people, and experiences, I’m thankful for each.

What would you advise others thinking of similar career paths?
With regards to the field of Regulatory Affairs, my belief is that it is helpful to bring a skill set to the profession (science, technology, engineering, math) and that one of the most important attributes is to have good interpersonal skills including the ability to communicate effectively (verbally and in writing). 
 
What have been some of your biggest obstacles and how have you overcome them?
Myself.  We often get in our own way by over analyzing things or lacking self confidence.  The way to overcome is to take chances, and if things don’t workout you re-direct.  I believe this is a key to life and to success.  Don’t be afraid to make a mistake, acknowledge it, own it and move on.  If you miss “acknowledging” it, I believe this can be a detriment to leadership and slow your development. 
Don’t pass up opportunities, take chances! 
 
How has your background, gender, race, or any other aspects of yourself been an asset?
The fire inside of me comes from my background, gender, race.  Being an immigrant to the United States, which I believe is truly a place of opportunity whereby you can own your trajectory…what was instilled in me since being a very young boy is that I was different and that I had to work, work, work to have access to the things I wanted.  In sports, in school, in my work, I was raised to not be outworked.  I have learned in sports and in my profession that hard work does not always immediately yield what you expect, but if you keep at it…the model stands up and the results are there. 
This approach is common in sports and has a common thread in life with work and relationships.   
Growing up in St. Louis, Missouri my parents and family, we routinely spoke Spanish in stores, around town which was not as common in the early 1980’s compared to today.  We would get funny looks at times. This language skill that I did not think much of in my childhood also had a significant impact on my professional development when I entered the field of Regulatory Affairs.  English is the global language for business, however, when I interacted with my colleagues in Latin America being able to read and speak, and write Spanish was a huge asset.  The best part was that I routinely take the opportunity to work on my Spanish while my international colleagues use the opportunity to work on their English. 
 
Overall, I’ve had the kinds of experiences that any ethnic minority has in the United States.  I can say with certainty that the eyes and ears of your colleagues and bosses are blinded to your differences when you bring value and success to the work.
 
I am very thankful for the persons that I have shared my career with, very thankful and humbled by my experiences.

​My name is Julieta Saluzzo, and I am 28 years old. Born and raised in Rosario, Argentina, I came to the United States at the age of 9 with my parents and younger sister in search of a more tranquil and financially secure life with more opportunities. My background is something that I have always treasured and which has allowed me to open my mind in many ways. Because I was raised in the US where there is so much diversity, and also having been raised partly in Argentina, I have always been aware of the many different ways of living that exist in our world. This has allowed me to explore with an open heart and mind and to understand others’ stories and realities. In addition, being a Hispanic woman in science and public health has allowed me to pursue invaluable opportunities in research to leverage myself and my career, such as the Mount Sinai International Training Program.
 
When I look back on my last decade, I see how far I have come: college, personal experiences, graduate school, international research internships, and my first job (fortunately enough, my dream job). I also see that every experience has built upon the ones before, something that I was unable to see at each stage. Lastly, I see that throughout my 10-year journey, there were people who helped me in many different ways. Each of these individuals who have made significant impacts on my life has given me skills, values, and qualities to equip me for not only a fulfilling career but a meaningful and purposeful life. Without these people, whom I call mentors, I would not be the person I am or be standing where I am today.
 
The Beginning of a Journey
My career path was neither planned nor straight, and growing up, I never had a vocation or knew what I wanted to do or be. In fact, I never would have imagined that I would be in my current role as I did not know that such a job existed until well into my college years. As a curious person, my interests have been many and varied. Yet it was my fascination with the life sciences and my desire to help humans that led me towards health sciences.
 
After exploring different health-oriented fields in college, I decided to pursue medicine given my interest in infectious diseases and intent to help and work with people. At the time, I thought it was the only career that would suit me. Having decided to take a gap year to apply to medical school, I began working in the research lab of one of my professors whose medical pathology class fueled my passion for learning about infectious diseases. This was a basic science lab that studied steroid hormone action in a breast cancer cell model and was my very first exposure to academic research. The skillset I gained during this role, including my very first publication and the abilities to mentor and train young students, would set the foundation for every experience that would follow.
 
During this time, I began to question my choice to pursue medicine, as I realized that there are many different fields that encompass my interests and perhaps better fit my curious nature. Additionally, I was starting to realize that medicine would be a huge undertaking for me personally. Therefore, I decided to expand my career lens and began exploring other options.
 
The work I was doing in the lab was enjoyable and I was quite good at it, yet there was something missing: the people aspect. Around this time, one of my friends was entering her MPH program. After speaking with her about what public health actually was (because I really had no idea), it sounded like the perfect combination of skills and tools to succeed in the areas in which I was passionate. One year later, I was the one embarking on my own Public Health journey at the University of Michigan School of Public Health.
 
My Experiences Abroad
 
For me, traveling is a way to meet people, get to know other cultures, and expand my view of the world. The way that I prefer to incorporate travel into my life is by experiencing the day-to-day in a new environment by working and/or studying abroad. I have already had two incredible opportunities to do this, and I am striving for more in the near future.
 
The first time I completed an international research internship was during my MPH in 2016. I went to Santiago, Chile and worked at INTA, the “Instituto de Nutrición y Tecnología de los Alimentos” in the microbiology laboratory under Dr. Angelica Reyes, where I studied the effects of copper on Listeria monocytogenes. This experience has enriched me in ways I could never imagine, by making life-long friendships and mentorships, learning what it means to do research with varying levels of resources and language barriers when it comes to publishing.
 
I enjoyed this experience so much that I decided to pursue an additional international research program at the end of my MPH. As a Mount Sinai International Program fellow under the mentorship of Dr. Luz Claudio, I went to Dublin, Ireland. Before departing to our host countries, we had a week-long orientation in New York City. This was one of the most memorable weeks of my life. As part of the orientation, we received training in different areas of conducting research, heard from previous alumni of the program about their own experiences and where they are now, and prepared ourselves personally with Dr. Claudio for our research abroad.
 
In Dublin, I worked at Trinity College of Dublin in the laboratory of Dr. Laure Marignol, where I researched biomarkers for treatment resistance in prostate cancer cells. This experience allowed me to use the skills I learned in my first research experience with my professor in the lab by coming from a subject matter expert viewpoint and enabled me to develop my mentoring skills by teaching new students.
 
Through the Mount Sinai International Program, I built strong relationships with mentors who have shaped and guided me throughout and long-after the internship. They have provided support, guidance, opportunities for the future, and friendship. The benefits of doing an international research internship are life-long, providing skills and invaluable opportunities that will not only make you a better professional in your field but a better human being.
 
Fast Forward to the Present
 
Currently, I am the Legionella Epidemiologist at the Department of Health in Washington DC. My role is split between that of an epidemiologist and a program coordinator-which is great because I get to do both research and applied public health work. As an epidemiologist, I conduct surveillance and investigations of cases and outbreaks of Legionnaires’ disease. As the coordinator for the Legionella Surveillance Program, I collaborate with and serve as a resource to stakeholders (e.g. other government agencies, healthcare facilities, the public) for Legionnaires’ disease prevention activities in DC.
 
During the Mount Sinai International Exchange Program, the importance of networking and mentorship was very encouraged. The way I arrived at my current position at the health department stemmed from the opportunity to network with one of the program alumni, Dr. Sasha McGee, whose journey reminded me very much of my own. After the program, I reached out to Dr. McGee seeking guidance during a time of uncertainty, and little did I know how much that would impact my life. After that initial phone call, Dr. McGee became a mentor to me, guiding me through the job-seeking process and giving me encouragement and advice. Eventually, I obtained a position working alongside Dr. McGee, one of the people whom I most admire. The past 10 years have not only allowed me to design my trajectory but to discover myself and my place in the world. Looking back at my career trajectory, I see that the job I hold now beautifully and delicately reflects my story thus far.
 
Obstacles Along the Way and the Tools for Overcoming Them
 
Of course, no journey gets on without a few walls to break along the way. Since I was very young, I have struggled with anxiety, and during my educational and professional experiences, impostor syndrome. Over time, I have learned to recognize them and deal with these head-on by working hard and with support from my friends and family. One of the ways I have worked through these is by learning to prioritize my own mental and physical health when necessary by doing activities that relax me and bring me joy, such as cooking and baking or going out for coffee with a dear friend.
 
Some tools that have helped me during tough times have been journaling and having a friend to talk to who understands what I am going through. I have also learned to trust my intuition and judgment in situations (from past positive experiences), allowing me to form a secure relationship with myself. These actions have helped to strengthen my self-confidence and self-efficacy. Lastly, I have never let myself shy away from doing that which drives my anxiety and impostor syndrome because that is adding fuel to the fire. You must find the water that will put it out instead- in my case, the positive experiences I’ve had, the amazing people I’ve met along the way, and recognizing the meaningful impact I have had on the world.
 
Looking in Hindsight and Advice to the Future
 
If I could go back ten years, there are some things that I wish I would have known or done differently. First, the realization that there are many different paths to many different outcomes: I wish I would have known that there are interests and there are skills and that those can be very different from each other but can be readily intertwined in many different jobs. While I do not regret the path I carved out for myself (I am actually very proud of it), I would have been more patient and less pressured.
 
Second, I wish I would have known to reach out to professors for research opportunities or internships during my undergraduate. Being a first-generation US college student, I did not know that  I could have sought out internships like the Mount Sinai International Program during my undergraduate and would have reaped the benefits of mentorship and networking much earlier in my career.
 
My advice to others in similar career paths would be to not shy away from contacting professors whose research you find interesting, or alumni whose advice you seek on potential career paths. Most, if not all of the people you approach will be more than happy to speak with you and share their stories.  And one never knows who will serve as a mentor and in what way. I would also advise others to say “yes” to each and every opportunity that comes your way because there will almost always be something to take home. Lastly, I would advise others to not worry about forming the perfect or most straightforward path-  just follow your interests, curiosity, and strengths, and the path will shape itself.

Caption: ​Dr. Sharon Attipoe and her three children, honored with Dr. Jonathan Fielding, Distinguished Professor at UCLA in the Fielding School of Public Health and the Geffen School of Medicine.

I was born in Ghana and remember growing up trying to find identity in the career path I wanted to pursue.  I was determined to be a lawyer because I got into trouble several times in school as “talkative”.  Yep, lawyers were chatterboxes in my mind!  It wasn’t until I emigrated from Ghana to the United States (US) that I had the thought of going into healthcare.  Even then I had the delusion of being a doctor and a lawyer at the same, although I now believe in that possibility more than I did back then.  In hindsight, this fiery attitude, together with my faith and beliefs were precisely the things I needed to get to where I am today.  
 
Identity
I have realized over the years that the concept of social descriptions of any human being is as complex as a spider web.  Being an immigrant, who spent my teenage years and early adulthood in the US, I have encountered the dichotomy trying to find my place in the world.  However, with time, I now consider myself plainly as a bicultural, millennial woman of African descent, Christian, wife, mom, scientist, author, and aspiring trailblazer in the field of health.  I left Ghana when I was 16 years to live in the US and to further my studies.  Throughout high school, I challenged myself with advanced courses while maneuvering the different cultures I was exposed to in my new country.  I liked discovery and learning about the way things worked because it was fun, but I was never satisfied with just reading theories from books.  Instead, I was fascinated with taking apart electrical objects, figuring out how the different components worked, then putting them back together.  With the lack of professional mentors in my life at that time, I pursued my interests solely based on gut feelings, the strength and wit I observed from the women in my life such as my grandmother, and my level of passion for different topics.  This experience has served me well as a female researcher who is capable of making both scientific and ethical decisions in my research projects. 
 
I finally encountered professional mentors such as Dr. Luz Claudio, who tugged on one of my strings of interests, which was to find a way to combine my love for the engineering sciences with the social sciences.  I was moved by her talk about finding my own path in my career.  Her words “find your own path in your career and be open to opportunities for career options that may not even yet exist”.  That advice sticks with me even today, because I am able to appreciate the beauty in the way I think, the way I like to approach solutions to problems I am passionate about solving, and also the way I see the need to make research impactful, and not just some type of academic activity. 
 
This way of thinking came into play when I was considering how to present findings from a recent economic study for an abstract on dissemination and implementation.  I induced the fact that research brokering in the field of dissemination and implementation requires stakeholders who always come to the table with the focus of what is in it for them.  How does the engineering part of my brain deal with this?  Imagine that the various frequency channels of radio stations represent the different stakeholders and turning the radio dial to the frequency of interest corresponds to a particular stakeholder.  When a stakeholder affiliated with that specific frequency, then the needs of that stakeholder are met.
 
Critical to my finding balance in both my work and personal life, are my faith in God and the support of my family.  I am blessed to be married to my best friend for over a decade, and we have three beautiful children.  Being a successful female scientist is not an easy feat without having an outlet in my life where I am constantly reminded of who I am and what my capabilities are.  I am fortunate to be able to have outstanding support from my husband and our three amazing children.  My family is more than an asset to me as I look back at the critical decisions I have made in my career and how they are all linked in one way or the other to the birth of my three children.  I am forever reminded to be present in this fact with every obstacle I face in my work on a daily basis. 
 
Journey
My interests have always been related to the influence of technology and engineering on health. Consequently, after completing my Master’s Degree in Biomedical Science and Biotechnology, I went to work for a company that manufactured medical devices.  During my several visits to health delivery centers, I was constantly drawn to the impact these devices had on patients’ health and what policies were in place to ensure that these devices were not only available to improve health outcomes but were used safely as well.  I majored in health services research during the course of my Master’s in Public Health and had the opportunity to learn about the US healthcare system and the discussion around access, quality, and costs driving healthcare.
 
In the course of my graduate school education as a doctoral student, I had the opportunity to learn more about the healthcare system of the US.  My analytical and scientific communication skills prepared me for my internship at the University of Cape Town, South Africa, where I designed and carried out research on media coverage of a HPV vaccination campaign.   I gained experience in proposal development, manuscript writing, the conceptualization of a research framework for analysis, coding of media articles, and developing a database with variables in addition to performing descriptive analyses.  In addition to completing the project, I presented my work to a panel of researchers at the University of Cape Town and published my work in the Southern African Journal of Gynaecological Oncology.  The challenge involved with conducting research abroad in a limited amount of time was one I had to learn to overcome.   My ability to adapt to these challenges and produce results has prepared me for working in similar settings.   My academic achievements span different research contexts and include international research experience in Ghana.  I worked at the Ghana Health Services and conducted a comparative cost-effectiveness analysis between two outreach programs with a target population of pregnant women.
 
All of these achievements were not without obstacles, but with my continuous belief in the purpose God and the help of my family, I was able to overcome the several obstacles and still continue to flourish in my journey.  I have a husband who was willing to sacrifice immediate financial comforts and his time, to enable me to pursue my doctoral degree.  My mom stepped in to help raise my children during the course of the degree, and more importantly, my amazing children, who quickly understood their mom was working towards something important, provided me with great support in their own little way.  The best moments of my daily journey are when I get to share my professional feats with my family, especially my children.  I shared with my children the joy of publishing a children’s book that is dedicated to them.  I also take them to conferences and work events.  I regard these moments as priceless components of my journey.
 
Balance
Throughout my journey, the opportunities or coincidences that I have come across have all played a critical role in molding and tempering me into the role I am in now.  Experiences such as seeking research internships and fellowships to gain real-life experiences, and my decision to conduct primary data collection for my dissertation work, which granted me the opportunity to gain a life-lasting friendship with my dissertation supervisor, have all been impactful in shaping my career path.  Throughout all these experiences, the primary factor that made the most difference, although I wish I had been exposed to these earlier in my career, was professional mentoring.  My fortunate encounters with mentors, both personal and professional, who believed in my capabilities and my natural curiosity to learn have truly been rewarding.  An example of a great professional mentoring experience is currently at the CDC where my mentor told me on the first day of my fellowship that he wanted me to present to a Task Force, comprising of a team of public health experts, on the topic of the economic evaluation of a community-based intervention.  I thought he was joking, but he confirmed it the next day, and I did not regret his decision. 
 
I will be remiss, however, if I did not mention the importance of finding a balance both with my work and life outside my career.  Within the space of my career, there is the constant challenge of finding the balance between my voice and interests and advice from experienced individuals.  In my personal life, finding the balance between what I can handle independently and when to lean into the fantastic support of family and friends is the daily lesson.  Finding the balance also involves identifying the parts of me that are unique to me, that enables me to enjoy life, and bring my family closer despite the constant time battle between life and work.  Singing at church, traveling with my husband and kids, and watching TV shows with my family help keep me grounded and staying present to what is important.  These moments allow me to excel in my career.  Identifying this strength is a necessary part of making career choices and the boldness to undertake such decisions is not always easy.  If there is anything I would have liked to learn earlier in my career, it is to have someone to share this truth with me.  Seeking further funding opportunities to alleviate some of the financial strain I encountered in my doctoral degree program is something I would have loved to have known earlier in my career as well.
 
In the grand scheme of things, my ability to take advantage of all the opportunities that came my way, such as the excellent opportunity to be a student board member of AcademyHealth, has created a great network that I heavily depend on in my career trajectory.  If I were to provide some advice for upcoming students, it would be to find their passion, seek  funding, and create a support system to help them achieve their goals and dreams.  Investing in myself, no matter how difficult, being more open to reaching out to people, believing in my God-given purpose, sharing my dreams, not being afraid to take risks, and being fortunate to have the support of my family, have been critical elements to helping place value on my skills and expertise. 

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. 
​

Guest Blog Post: Dr. Bahby Banks was one of my first students in the International Training Program.  After completing her doctoral degree, she has become a successful business owner, motivational speaker, and consultant.  She helps other women of color envision their futures and helps businesses evaluate their programs.  She is always a welcome guest speaker for our group of new students.  
Here is Bahby's story in her own words. ​

I participated in the inaugural Mount Sinai School of Medicine (MSSM) Exchange Program for Minority Students in 2006, shortly after I completed the first year of my doctoral studies at UNC Gillings School of Public Health.   My research internship included placements at Fundacão Oswaldo Fiocruz in Rio de Janiero, Brazil and Hospital Alvarez in Buenos Aires, Argentina.  Dr. Claudio did an amazing job of preparing us for our internships, including a week-long orientation in New York City. During this week, we were introduced to local researchers and scientists, provided with instructional language CDs and given literature that detailed the importance of inclusion of underrepresented populations in research.  Every single detail of orientation week wreaked “love” and “investment” from Dr. Claudio and her staff.
After orientation, I made my way to my first placement at Fundacão Oswaldo Fiocruz, where I worked with Drs. Lucia Rotenburg and Rosane Greip to explore gender differences in work ability among Brazilian nurses. My lab consisted of about five young researchers—all women- who investigated various aspects of Dr. Rotenburg’s research.  My work with the Fiocruz team continued after I returned to United States, and resulted in a peer-reviewed publication (Rotenberg L, Portela LF, Banks B, Griep RH, Fischer FM, Landsbergis P. A gender approach to work ability and its relationship to professional and domestic work hours among nursing personnel. Appl Ergon. 2008;39(5):646-52)! The following year, I traveled with Dr. Rotenburg to the 18th International Symposium on Shiftwork and Working Time in Australia—where I was the only delegate from the United States.  Quite an honor!  
My second placement in 2006 was in Buenos Aires with Dr. Diana Gilamberti, director of Obstetrics and Gynecology (OB/GYN) at Hospital Alvarez.  I worked with another Mount Sianai intern to develop a survey to explore the use of petroleum-based lubricants among sex workers receiving services in the OB/GYN department.   This was probably one of the most intriguing experiences that I’d as a budding researcher, as Dr. Gilamberti invited us to share the survey findings with two sex worker union representatives in Buenos Aires.  The representatives responded with such passion and were adamant about prioritizing the safety and health of “their girls”.  The response to raise awareness about the dangers of petroleum-based lubricant use was the quickest I hade seen for any public health effort.  By the end of my internship, the local health department began supplying the hospital with condoms packaged with lubricants.  They also made them available at the local health department.
My journey to become founder and CEO of Pillar Consulting, Inc. was a very non-traditional one.  I knew very early on during my doctoral training that I wanted to serve as a faculty member and independent research consultant.  I did not, however, have a “roadmap” to guide how I could navigate both of these roles successfully.  I had a powerful network of mentors to guide my steps in academia, offering opportunities to contribute to research in historically oppressed communities.  Opportunities did not always present themselves in “traditional” ways, but I was very proactive in seeking leadership and research roles that supplemented my academic training.  Many of my mentors, including Dr. Claudio, were not in my department, but they were invested in my growth as a researcher.
The most powerful shift as a research intern was learning my role as a contributor to research.  The Impostor syndrome is very real, particularly for people navigating industries that have historically excluded women and racial and ethnic minorities.  I did not always feel that I belonged—despite doing all of the work to earn my seat in the room. But, sitting alongside senior women researchers who successfully navigated the academy was priceless.  It was a mirror of sorts for where I wanted to be after I completed my studies. 
Two things I learned over the course of my training: 1) Your work will always speak for you and 2) Think outside of the box.  My applying for the Mount Sinai International Exchange Program for Minority Students was an example of the latter, as this type of training program was not available at my home institution.  I participated in several internships over the course of my studies, and while the variation in topic areas appeared as a “lack of focus” to some faculty, I knew exactly how these opportunities could build my professional portfolio.  I knew that I wanted to add international training to my professional portfolio, and these internships afforded the opportunity to supplement the training I was learning in the classroom. As a result of seizing these opportunities, I was able to conduct research at the World Health Organization, Fundacão Oswaldo Cruz, Hospital Alvarez, and ultimately worked with an amazing research team in rural North Carolina.

My love for program evaluation and mixed-method approaches led to my current career as a business owner and independent research consultant.  During my doctoral studies, I enrolled in courses and took advantage of external training opportunities to develop my research skills (e.g., qualitative methodology, racial and equity training, community-based research).  Business development took a little more work, as I didn’t know any researchers navigating the path of entrepreneurs! I did, however, reach out to several men and women in my network who were entrepreneurs to glean what wisdom I could to position Pillar Consulting as a competitive company.   Networking was key!

I share with my mentees the importance of having a “tangible” when they complete a research internship—something that documents their contribution to the research.  This “tangible” might vary from place to place: a conference poster, oral presentation, brief, video or peer-reviewed publication.  No matter the case, the goal is to share your findings.  Dissemination is key in ensuring your work, and the work of the communities you serve.  As an academician, peer-reviewed publications are essential to building your tenure package.  Scientific writing in essential to sharing your work with the Academy. 
 
Now, as a business owner, I focus most of my work with Pillar Consulting on historically oppressed populations whose voices have not been part of “best practices” shared in the literature. That said, we work with clients to help build their capacity to lead and contribute to the dissemination of their work.  We, as research scientists, continue to partner across the county to disseminate the work of our partners.
 
Participating in Dr. Claudio’s internship helped me achieve my career goals.  There is power in being able to say that part of your academic training included contributions in national and international settings.  By the time I completed my Ph.D., I had co-authored several peer-reviewed publications in national and international journals, presented at conferences around the world and had a vast network of colleagues around the globe. These opportunities laid the foundation for me to become the researcher I am today!
 
I would not be where I am today without mentors who were invested in my success and growth as a public health researcher. As a military dependent, I was accustomed to being in a variety of academic settings—public, private, predominantly White, or predominantly Black—but I was the first (but not last) member of my family to pursue doctoral training.  In more ways than one, there was no a roadmap for me to follow.  My mentors, near and far, were open and transparent about their journeys in research, and pushed me to raise the bar for myself.  They believed in me when I didn’t believe in myself and challenged me to (literally) use my voice at the decision-making table.  They helped me see my dual role as a trainee and contributor to research.
I continue to grow as a leader and evaluation researcher every day.  My goal of building community capacity in research has not changed, but my approach has.   My team is committed to working with an equity-based lens. We are working with partners whose approaches include social determinants of health and structural-based approaches to improving the human condition.

What I say to new students in these internship programs is this: Use your voice.  In the words of the late Shirley Chisholm, “If they don't give you a seat at the table, bring a folding chair.”

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. 

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.”

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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.

Meet my former student, Sasha McGee, PhD, MPH.  I met Sasha when she was still exploring her career options.  After writing two papers while working as an intern in my research training programs, Sasha strengthened her credentials to pursue a career in epidemiology.  Sasha is now a Senior Infectious Disease Epidemiologist at the DC Department of Health.  Read about how she went from MIT doctoral graduate in technology to a meaningful career in public health.
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One of the greatest challenges I faced while pursuing my education was not knowing what I wanted to do—professionally that is. I knew a lot about what I did not want to do (e.g., to do bench-work, to teach), but only had the faintest ideas of what I wanted to do. I knew that I wanted to do applied work that related to health, but exactly what that meant in terms of a career, I did not know. And so despite having no end goal in mind, I wrote essay after essay about my intended career path (nothing more than wild guesses really!) for various applications when they asked me the dreaded question. I even went as far as obtaining my doctoral degree based on these carefully crafted paragraphs. But after all those years of education—a bachelor’s degree in chemistry and doctoral degree in Health Sciences and Technology—I reached a point where I decided I needed to figure out this question of what I really wanted to do once and for all.
 
I began researching careers in public health online fairly early on since it fit the criteria of being an applied field. After years of conducting research, I wanted a career in which I would be able to clearly see the impact of my work. I also knew that I did not want to just sit in front of a computer all day, but be able to interact with people. Initially, I thought that global health would suit me since I loved to travel. I began arranging meetings to learn more about this field, to get career advice, and explore masters of public health degree programs. I also attended some conferences in order to learn more about what was going on in the field and explored companies where I could potentially work. However, there were two major hurdles I soon discovered when it came to transitioning to this field. First, no one understood what my graduate degree was or meant when they reviewed my resume. Second, although I had a doctoral degree from the Massachusetts Institute of Technology, no one wanted to hire anyone without any work experience. 
 
I will cut out the painful parts, but needless to say I spent a great deal of time and effort trying to get a job without making any progress. Unfortunately having been in school all my life had not prepared me for how to successfully apply for jobs and I discovered there was a steep learning curve. I was able to arrange an internship (unpaid) at a local health department, which was an invaluable experience for me in terms of being exposed to public health. I also did a bit of consulting work, worked as a medical assistant, and completed a short-term research position similar to the kind I did in graduate school. Given my lack of progress in the job hunt, I decided I would return to school to get a master of public health degree sooner than I had initially planned. I reached out to a college classmate who I had spoken with previously to assist me in selecting a specific focus area since he was pursuing a doctoral degree in public health. It was through my discussion with him that I first learned about the field of epidemiology. It seemed interesting and to be a great fit for me given my analytic nature. After a great deal of internet research to understand exactly what epidemiology was, I was able to write the essays for my applications and my classmate kindly reviewed them to make sure it sounded like I knew what I was talking about. I ended up pursuing my master of public health degree in epidemiology at the University of North Carolina at Chapel Hill. Finally, I was not just going to school, but rather I was preparing myself for my career. It was a great experience!
 
I am grateful to God for enabling me to do everything I have done, every opportunity He has provided, and for sustaining me even when my career was at a standstill. As I think back over my journey, certain things have been invaluable to my educational journey and career—first and foremost of which were strong writing skills. I have had to write countless essays, cover letters, responses to questions, etc., while pursuing various opportunities. At times I needed to be able to clearly and concisely convey information within tight word limits. Other times I had to persuasively answer pointed questions to make a case for my qualifications. In some cases, I was given free rein to address a question or topic and needed to compose an essay or short statement that would powerfully impact the readers and make me stand out from the rest of the applicants. Initially I felt daunted by each writing task, but after a while I began to see the various writing assignments as a sort of friendly challenge—something that could be conquered, although it often required a great investment of time.
 
I learned another invaluable lesson from my advisor as I was pursuing my doctoral degree. When giving presentations, tell a story, don’t just present information (e.g., data in my case). This is actually also equally applicable when writing scientific articles. The tendency is to share everything—I definitely had that tendency. However, as exciting as the data are, when they are presented in the form of a story they are far more memorable to your audience.
 
Currently, I am a Senior Infectious Disease Epidemiologist at the District of Columbia Department of Health. I absolutely love my work. I wish I could say it was a smooth journey once I figured out what career I wanted to pursue, but there were still more bumps along the way. As I share my experiences and encourage students and early career professionals who are just starting their journey, I realize how many others are experiencing the same challenges I did. Don’t despair; you are not alone in your still trying to figure it all out! Perhaps like me, you also have not yet been exposed to the specific field you will ultimately choose to pursue. I encourage you to take your time to investigate various career options online, talk with people to learn about potential career paths and get advice about careers you are considering, and to gain work experience along with your education. -- Sasha McGee, PhD, MPH

Sometimes, you meet that great student who knows exactly what she wants to be when she grows up.  All she needs is for you to usher her along to bigger and better opportunities.  One such student who I had the privilege to mentor is Magdia De Jesus, who I met when she was very young and now she is an assistant professor with her own lab and students.  In this guest post, Dr. De Jesus tells us her story.  Enjoy!
 
Since I was 9 years old, I wanted to be a scientist and although the odds made that dream seem impossible, I can tell you that the reason why I am a scientist today is because I AM A PRODUCT OF PIPELINE MENTORSHIP! Hello, my name is Dr. Magdia De Jesus and I am an Assistant Professor, in the Department of Biomedical Sciences at the University at Albany, State University of New York. My research laboratory is located at the Wadsworth Center, New York State Department of Health.
I was born in Utuado, Puerto Rico on a very warm and rainy February morning. At seven months of age, I moved to East Harlem, New York City where I lived in a one-bedroom apartment at the Wagner public housing that is part of the NYC Housing Authority (NYCHA). Although my parents had very little education, they both knew how to read and write. My father worked very hard as a marble polisher in a factory located in the South Bronx and my mother stayed at home taking care of my sister and I. Both of my parents understood that the only way that they could give us a better future was by encouraging us to do well in school. 
From the window of this one-bedroom apartment, I could see the beautiful lights of the Tri-borough bridge that connects Manhattan with Queens and the Bronx.  I always wondered what it would be like to cross the bridge into Queens and the Bronx to see what the world had to offer. As a young child, I also dreamed about becoming a scientist and a professor. I became fascinated by a science TV show that I would watch every morning called Mr. Wizard’s world on Nickelodeon. My fourth-grade teacher, Mr. Victor Diaz at P.S. 206 also shared my same passion for science and he incorporated science into everything. Interestingly he did many of the experiments that I had seen on Mr. Wizard’s world.
My parents recognized my enthusiasm for science, but they were worried about letting me down as they did not know any scientists or where to even begin. I was very fortunate that my high school the Manhattan Center for Science and Mathematics had a very special partnership with the Mount Sinai school of Medicine.  The program was called the Mount Sinai Scholars Program and it was supported by the philanthropic efforts of Edith K. Erhman. The program was unique because it took promising high school student, interested in science and medicine under its wings starting from the 10th grade. The program provided paid summer internships, an SAT PREP course and an invaluable network of scientists and physicians who opened our eyes to both the rewards and challenges of careers in science and medicine. The program also had a unique mentorship model as we not only had the program director Susan T. Cohen to guide us, but all of us had a mentor who we directly worked with and we also had a program mentor who was “our buddy”.  I was very fortunate to have Dr. Mark W. Babyatsky, a gastroenterologist and scientist as my research mentor who taught me all about somatostatin receptors in the GI tract when I was 14 years old. As you can imagine it was a dream come true. I was also very fortunate to have Dr. Luz Claudio as my program mentor who is still very much present in my life as a colleague and friend.
When I graduated high school, I went to New York University (NYU) where I majored in Biology and I minored in Sociology. At NYU, I experienced several academic challenges and was highly discouraged to continue as a Biology major. My academic advisor said “you are a good student but not a great one, you should consider  becoming a teacher” As you can imagine, I was devastated but this advisor’s comment fueled the fire, I knew that I was going to complete my degree and although it took me an extra semester, I became an NYU graduate with a major in Biology and minor in Sociology!
During my time at NYU, I had continued to stay in touch with Sue Cohen, the director of the Mount Sinai Scholars Program and Dr. Luz Claudio. With Sue’s help, I was part of the Child Health Plus (CHIP) team that helped recruit and insure thousands of children who did not have health insurance all over NYC. This experience not only taught me a lot about public health and networking, but it let me cross the bridge into Astoria, Queens as Mount Sinai had a satellite clinic there. At the end of the CHIP program, Dr. Claudio also gave me the opportunity to experience more public health through her environmental science summer internship program.
While participating in Dr. Claudio’s summer program, Sue Cohen asked me if I would be willing to participate in a new two-year pilot post baccalaureate program that was being developed by Dr. Terry A. Krulwich and Dr. Gita Bosch the Deans of the graduate school at Mount Sinai. I immediately said yes because I understood that this program would be my ticket into a Ph.D. program. The Post Baccalaureate Research Education Program (PREP) gave me the opportunity not only to shadow the graduate students by taking classes but I was also given the opportunity to do my own research project in the laboratory of Dr. Krulwich. I not only learned how to do bench science, an opportunity that I did not get at NYU, but I also learned how to break down and read scientific papers. This was an invaluable skill that Dr. Krulwich pushed hard on me as she would meet me every Wed morning at 8 am in her office to do a journal club type exercise. Dr. Krulwich also gave me the opportunity to present my work at the American Society for Microbiology (ASM) conference in Salt Lake City, Utah. At this particular conference, Dr. Krulwich encouraged me to attend any session during the last day of the conference and I chose to go to the fungal pathogens session where a renowned scientist from the Albert Einstein College of Medicine went into a heated debated with another scientist in the audience who challenged his work. I was impressed by all of these things that I had learned by going to the conference and I will always thank Dr. Krulwich for teaching me not only the science but how to build a thick skin and not let criticism break me.
PREP was my bridge to the Bronx, as I chose the to go to the Albert Einstein College of Medicine to do my Ph.D., ironically, Dr. Claudio is an alumnus of Einstein.  I also chose to become a graduate student in the laboratory of Dr. Arturo Casadevall, the scientist who was involved in the impressive debate with the audience member at ASM. In Dr. Casadevall’s lab, I learned to do elegant science and during my six years in the program, I learned so much about science, the world and myself. I then moved on to do a postdoctoral fellowship on Emerging Infectious Diseases sponsored by the Centers of Disease control (CDC) and the Association of Public Health Laboratories (APHL) my host institution was the Wadsworth Center, New York State Depart of Health. At Wadsworth, I learned a lot about public health and outbreak investigations under the mentorship of Kimberly Musser, the Director of Bacterial Diseases. I was also fortunate to be able to stay at Wadsworth during the recession and do a second postdoctoral fellowship sponsored by the Howard Hughes Medical Institute (HHMI)- Life Science Research Foundation (LSRF). My mentor Dr. Nicholas Mantis not taught me about mucosal immunology but also to become a stronger writer. Dr. Mantis also became my advocate and was instrumental in helping me obtain my current position as faculty member at the University at Albany and the Wadsworth Center continued to support my growth by providing me with the laboratory space and the tools that I needed to establish my own research program.
Currently, my laboratory is full of young, vibrant and diverse students who are eager to learn from me about vaccines and emerging fungal diseases.  I have made it a point to pay it forward by sharing the knowledge and skills that I have learned with my students, with children in my community and through the Skype a Scientist program that allows me to have a small impact at the national level. So, you see, dreams are possible even when the odds are stacked against you. All you need to find, are those bridges of opportunity, those selfless mentors who walk with you throughout each leg of the journey and the mentors who will be with you for a lifetime. Thank you, Dr. Claudio for giving me this opportunity to share my story, a story that you helped develop and continue to have significant impact.