As a medical student, my goal is to improve the prevention, identification, and treatment of child abuse. Eight years ago, I volunteered in a crisis nursery. The nursery served as a safe place for parents to leave their children during an emergency. One Saturday, I worked with two small brothers who had been abused. I became mildly traumatized, haunted by the idea of what they had experienced. My school counselor advised me to focus my time on other endeavors until I was older. I had already been working part time at a flower shop and looked for a second part time job that would be intellectually demanding. I was hired as a Spanish-speaking clinical research assistant at the Washington University in St. Louis Medical School.
My research team worked on a study called the Contraceptive CHOICE Project, which is the largest prospective cohort study of contraception to date. Our team provided free birth control to over 9,000 women and studied their decision-making. I was the youngest research assistant by six years and the only one that did not have a college degree; in fact, I was still in high school. Hearing about the hardships my participants faced and the relief they felt in planning their pregnancies cemented my desire to pursue a career in medicine. Still, the memory of those two boys haunted me.
I continued working with my research team for the next six years and gradually earned more responsibilities. I took ownership of a substudy asking the high-impact question: could intrauterine devices (IUDs) be safely inserted in women that were at high risk of sexually transmitted diseases (STDs) instead of waiting until after STD treatment was finished. This would allow low-income women easier access to the most effective form of contraception. This research led me to be primary author on two paper publications presenting my cutting edge data, and I hoped the new evidence would improve clinical practice.
The results from the overall study, the Contraceptive CHOICE Project, have been highly influential. Though our team’s work has featured in two New York Times articles, the most meaningful influence has been in establishing the evidence for Colorado to implement a private grant to provide contraception for free to all women in the state. The birthrate for teenage mothers decreased by 40% and the rate of abortions decreased by 42%, with the greatest drop in impoverished minority women. Improved access likely contributed to this effect.
I plan to continue influencing policy and improving clinical practice. Through my first research experience, I also found that obstetrics and gynecology was not the right field for me. When my favorite class in medical school was neurobiology, I decided to explore neurologic conditions. I worked as a teaching assistant for the neurobiology course during my second year of medical school and read an article about a little boy suffering brain damage from child abuse. This caught my attention and I decided to do research with a pediatric neurosurgeon. I developed in-depth knowledge on myelomeningoceles, neural tube defects associated with maternal folic acid deficiency. With this knowledge I became a primary author on a paper discussing the difference between prenatal and postnatal repair for obstetricians, neonatologists, and pediatricians.
I was intrigued by the ethical considerations of deciding whether to operate on the baby before or after it is born. Prenatal surgeries pose significant health risks to the mother, which can be tolerated if the surgery is necessary for the fetus to be carried to term. This is not the case with myelomeningoceles, and I therefore sought out the world-renowned professor of a medical ethics class I had taken. We worked on developing a novel framework for ethical analysis of innovations in surgery. The Stanford Hospital Ethics Committee has used our framework to help make decisions about when to oversee new surgeries.
In the years since I met the two little boys, I have developed research skills in reproductive rights, brain development, and ethics. Each field in itself did not satisfy me, but all are fundamental topics in the treatment of child abuse. This year, I finally felt ready to become more directly involved in the care of abused children. I began volunteering as a court appointed special advocate for foster children. I believe the power of well designed, caring research for underserved populations is untapped. I look forward to bringing my research skills to creating large-scale evidence-based innovations for treating child abuse.