To Walk Beside Raksha Narasimhan
Miller School of Medicine M.D./M.P.H. student Raksha Narasimhan’s essay about her cervical cancer prevention efforts in El Salvador was published in Academic Medicine.
Raksha Narasimhan was a sophomore pre-med student at UCLA when COVID-19 hit. Working as a contact tracer got her thinking about medicine as a tool not only for clinical care, but for patient education and advocacy.
“I wanted a career where I could see patients and touch individual lives,” she said, “and also work on a systemic and advocacy level.”
To Narasimhan, pursuing a dual degree in medicine and public health presented the perfect opportunity to combine these aspirations.
Cancer Care and Public Health
Today, Narasimhan is a third-year M.D./M.P.H. student at the University of Miami Miller School of Medicine. As a first-year student, she quickly discovered an interest in working with cancer patients. Fascinated by the links between cancer care and public health, she dove into research on cervical cancer. She was fascinated by the facets of public health it touched, such as social stigma, compliance with Pap smears, human papillomavirus (HPV) vaccinations and survivorship after treatment.
“Cervical cancer is a preventable disease that represents an intersection between public health and social stigma,” she said. “I looked at psychosocial factors like self-efficacy, guilt and shame, and how unlikely it is for women with those characteristics to pursue cervical cancer treatment.”
The stigma around cervical cancer, she said, can include post-traumatic stress disorder (PTSD) after treatment. She also learned about economic barriers to treatment, like the challenge some women face getting rides to screenings and cost and accessibility barriers in developing nations. Narasimhan was determined to find ways to ensure adequate social, financial and psychological support for these women.
Cervical Cancer Prevention Abroad
After her first year of medical school, Narasimhan received a Miller School Population Health Scholar award to travel to El Salvador with Basic Health International, a non-profit dedicated to preventing cervical cancer in Latin America and the Caribbean. During her month in El Salvador, Narasimhan worked with staff to ensure the provision of Pap smears, HPV screenings, colposcopies and treatments to remove pre-cancerous lesions.
While in El Salvador, Narasimhan created and implemented educational interventions to teach women with limited literacy about cervical cancer, post-treatment strategies and the anatomy of their vagina and cervix. The goal was to empower women by dispelling stigma and helping them learn more about cervical cancer, thereby encouraging them to seek treatment.
She also developed a training manual in Spanish that helped alert providers to the stigma some women face around cancerous lesions. The training manual discusses how to approach patients in a manner that won’t alienate them. It also helps providers understand that, for women struggling with literacy, the screening guidelines can be confusing.
The Women She Walked Beside
Recently, Narasimhan responded to Academic Medicine’s call for trainee letters to the editor. Her essay, “To Walk Beside Her,” was accepted for publication in the journal. In it, she describes her work at the clinic in El Salvador—the women she helped, the women who bore the scars of surgery, trauma and noncompliance, the women she walked beside.
Tracing the grooves of a plastic pelvis model, I explain to Maria her anatomy, her lesion, the post-treatment guidelines. She shares her journey: Three chicken buses, two hours of walking.
Excerpt from “To Walk Beside Her”
After medical school, Narasimhan plans to apply to radiation oncology residencies and hopes to specialize in breast and gynecologic cancer treatment. She feels fortunate to be at the Miller School.
“The patient population you see is so diverse at Jackson and UM,” she said. “It’s wonderful that I’ve been able to connect with patients in Spanish, learning from their sociocultural context in ways I can carry forward.”
In addition to her studies, Narasimhan is president of her class. She’s advocated for the class and for the curriculum, made sure the students feel supported, worked with deans and mentored the upcoming classes
“Everyone has unique reasons for entering medicine and for embarking on their chosen paths,” said Narasimhan, who plans to continue research and advocacy related to women’s health and the psychosocial barriers to treatment. “My experiences in medicine and public health have inspired me to dedicate my career to walking alongside women as they navigate cancer and survivorship.”
Tags: cancer survivorship, Cervical cancer, dual degrees, M.D./M.P.H. Program, medical students, Miller School of Medicine Student Government, student research