Leah Chen (C’25) is a physics major and public health minor pursuing pre-med coursework. This summer, she traveled to Northern Thailand where she worked with researchers at Mae Fah Luang University in Chiang Rai, close to the country’s borders with Myanmar and Laos. There, she contributed to an ongoing study of cervical cancer screening in migrant populations. Her trip was partially funded by a Royden B. Davis Fellowship, which is awarded by the College of Arts & Sciences for students to engage in transformative educational experiences over the summer.
The mountainous areas of Northern Thailand are home to many indigenous groups that migrated from Eastern Myanmar, Southern China and Western Laos for reasons ranging from political unrest to forced cultural assimilation. These ethnic minority groups are known as the hill tribes, with the six major hill tribe groups being the Lahu, Akha, Hmong, Lisu, Karen and Yao tribes.
Thailand’s universal health care system offers many free services, including regular Papanicolaou (pap) smears and HPV vaccines. In order to access these benefits, however, women must hold a Thai ID card, which is verification of their citizenship. Despite having lived in Thailand for generations, many hill tribe women do not hold Thai ID cards and are therefore ineligible for coverage under universal health care.
Leah Chen (C’25) sightseeing at Chiang Rai’s famous White Temple
Lack of health care coverage, however, is only one of the many barriers that prevent cervical cancer screening uptake. My primary objective this summer was to identify all of the barriers to screening through literature reviews and interviews with the women in order to develop an effective health care intervention to increase screening uptake.
Most of my time was spent preparing for an HPV screening workshop for the hill tribe women, hosted at Mae Fah Luang University. Ninety-five percent of cervical cancers are caused by HPV, making HPV a strong precursor and indication of cervical cancer risk. The goal was to create a workshop that would be most effective at increasing screening uptake.
To tailor this workshop, I reviewed more than four dozen research papers about common barriers to screening in similar populations as well as ways to overcome these difficulties. This information was then incorporated into the workshops. For example, past interviews with hill tribe women indicated that there was a common cultural value of modesty, which made pap smears highly undesirable due to their invasive nature. Informed by research, HPV self-screening kits were chosen for the workshop.
During one workshop, I led an activity of building clay models of the female reproductive tract in order to teach the indigenous women about female anatomy. I had preconceived notions that they would have little interest in having me, a foreign and young girl, teach them about their reproductive systems. Despite the heavy language barrier, however, I was met with so much enthusiasm. While we were able to laugh and lightheartedly poke fun at the clay models, many of the women also spoke up about some of their perceptions of women’s health, such as avoiding the gynecologist for fear of judgment. The openness and solidarity that I felt stood out to me, because our ability to connect simply as women completely transcended the bounds of language.
Leah Chen (C’25) with another student on the main campus of Mae Fah Luang University (MFU) in Chiang Rai, Thailand, where she has been conducting research this summer.
I have always been drawn to the interpersonal aspect of medicine and the unique relationship that is built between a patient and health care provider. This relationship is built on a foundation of mutual understanding that can only be achieved through active consideration of a patient’s identities. Social identities are a huge factor in health care. Whether it is race, religion, socioeconomic or migration status, I believe that as a future physician, I have an imperative to educate myself on the health care disparities that are systematic and institutionalized worldwide. While the research component was highly appealing to me, I found the experience of being immersed in a different culture to be absolutely invaluable.
I hope to continue researching barriers to cervical cancer screening and take my understanding of health disparities to the next level by pursuing a Master’s of Public Health prior to starting medical school.
This summer truly transformed in the way I value cultural relativism. There are so many underlying identities that inform health decisions — identities that must be examined closely by physicians to truly connect with their patients. I am humbled and grateful that these women were willing to open up to me and share aspects of their culture and way of life with me. This shed light on the nuances of medicine’s micro-level impact, which has only bolstered my ambition to become a doctor. This was an incredible learning curve for me, and I have returned to the United States with a stronger desire to discover more, meet more people and immerse myself in spaces where I can keep learning from people who are different from me.
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