Academics and Research / People

Senior fuses biology and geography in study of health care

In summer 2013, Jacqueline Smith journeyed to Dehradun, India, to work at Bella Health, a nongovernmental organization that empowers women to make informed family-planning and reproductive health choices. Photo courtesy of Jacqueline Smith

In summer 2013, Jacqueline Smith journeyed to Dehradun, India, to work at Bella Health, a nongovernmental organization that empowers women to make informed family-planning and reproductive health choices. Photo courtesy of Jacqueline Smith

When senior Jacqueline Smith came to the University of Denver four years ago, she intended to prepare for a career as a physician.

“Originally I wanted to go to med school,” she recalls. “I’d always wanted to since I was a child.”

That goal shifted over time, as she took classes across the disciplines and explored her various passions.

“I realized I wanted to work with population health, which is public health. I would rather focus on the needs of populations than the needs of individuals,” she says.

With that in mind, Smith opted for a double major in biology and geography, particularly human geography. Not content to limit herself to the sciences, she drew on programs in the divisions of Arts, Humanities and Social Sciences for two minors — one in art and one in intercultural global studies.

This combination of four different disciplines not only gives her a solid understanding of the behavior of microbes, it also allows to her make connections between, say, a community’s socioeconomic profile and the health of its members.

“There’s a huge aspect of understanding the role of culture within health,” she says.

In pursuit of that understanding, Smith has taken advantage of a number of opportunities. As a junior, she participated in a specialized study abroad program — focused on public health, race and human rights — in Salvador, Brazil. There, she enlisted her Portuguese language skills to conduct research with a social welfare program.

More recently, in summer 2013, Smith used a grant from Partners in Scholarship, a University program that funds undergraduate research, to journey to Dehradun, India. Dehradun, located in the northern state of Uttarakhand, is home to Bella Health, a nongovernmental organization that empowers women to make informed family-planning and reproductive health choices. According to a 19-month report published in October 2013, Bella Health serves more than 30,000 women in 577 villages throughout Uttarakhand.

In the months preceding Smith’s visit, Bella Health had surveyed roughly 500 women about their reproductive health and health care practices. Smith agreed to help Bella Health analyze some of that data and prepare a report for internal use and for submission to public health officials.

“My main focus was on abortion and access to reproductive health care,” she says, noting that she was seeking correlations between women who had abortions and their position in Indian society.

“We were looking at socioeconomic status — education, access to housing, cars, things that denote status or wealth,” she says. “The great majority of the women [who rely on Bella Health] are living at or below the poverty line — India’s poverty line. And most of these women had only gone through the first six years of primary school.”

Among these women, abortion was extremely common. In fact, the mean number of abortions was two. Some women had had as many as nine. “The end result,” Smith concludes, “is that women are using abortions as a form of birth control.”

For public health officials, this finding is significant. After all, abortions are more costly than pills or IUDs. They also present more risk. In fact, Smith’s report points out that 21 percent of the women reporting abortions experienced complications.

Smith’s data is being used not just to educate public health officials, but also to develop educational programming that “opens up the discussion of reproductive health rights.” She is especially proud of a new family-planning/reproductive health course for men, in which they learn about better birth-control options for the women in their lives.  They learn to compare the costs and risks associated with birth control pills and IUDs versus the costs and risks of an abortion.

Given the role men play in the lives of their wives and daughters, this course is especially promising, Smith says. Many women feel they must seek permission from their husbands and fathers just to make a visit to Bella Health. Still others won’t accept the advice of a doctor without first consulting with a male figure. To illustrate this, Smith cites the story of a woman told that her life would be imperiled unless she received a hysterectomy. Before agreeing to the procedure, the woman said she needed to ask her husband for permission. She feared that he would not be willing to give up the prospect of more children.

Smith doesn’t know if the husband agreed or if the woman even discussed the procedure with him. She does know that the patient was eventually hospitalized for emergency treatment that could have been avoided had she had the hysterectomy.

Public health NGOs like Bella Health have a huge task ahead of them, she acknowledges, but Smith is encouraged by the work they do. “I think it is changing mentalities,” she says. “That is great to see.”

What’s more, philanthropies like Bella Health are increasingly recognized for the work they do within India. As a case in point, Smith references the Dasra Philanthrophy Week, sponsored by the Indian Philanthropy Committee.  The committee has asked Bella Health to address the participants in the next philanthropy week, centered on “Girl Power,” and share its message about empowering adolescent females.

While in India, Smith did far more than crunch data.  She also worked at the clinic and came to know some of the employees. “All of the employees are native to the area. Almost all of them are women. There is one male who drives the ambulance. It is essentially a mini clinic on wheels.”

The mobile clinic offers basic services, such as prescriptions, prenatal care and checkups for newborns. Smith, who accompanied the ambulance team to some of its visits to remote villages, assisted in whatever ways she could. On one especially long day, she weighed and measured 250 children at an elementary school.

Smith’s experience at Bella Health has already paid dividends, beefing up her resumé  as she searched for work in her field. Today, just months from graduation, she juggles her coursework with a full-time job with Community Health Services. The nonprofit provides primary care to children through school-based health centers, and Smith works at Adam City High School, helping teens access everything from immunizations and contraceptives to nutrition counseling.

Without the Community Health Services program, she says, many of these students wouldn’t get any health care at all. “A lot of kids use this as their primary care physician,” she explains. Meanwhile, true to her aspirations, she’s working in a job that addresses the needs of populations as well as individuals.





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