VCU news

By James Shea

International health care has always been important to Helen Noble. The Virginia Commonwealth University School of Medicine student earned her undergraduate degree from Lawrence University in Appleton, Wisconsin, and traveled overseas through study abroad programs to Sierra Leone and India. In Sierra Leone, she spent three weeks on a project where she saw firsthand the challenges facing low-income countries.

“That was the first thing that got me interested in international work,” said Noble, now a fourth-year student in VCU’s International/Inner City/Rural Preceptorship program. “I toured rural hospitals with very few tools for patient care — no doctors, blood, surgical equipment, clean water or electricity. I met providers tirelessly trying to improve health in their communities, but their efforts were inhibited by the under-resourced health care system.” 

In the years since, Noble has traveled the world, and this past school year she earned a fellowship through the Global Health Program for Fellows and Scholars at the National Institutes of Health’s Fogarty International Center, allowing her to spend the 2019-20 academic year in Peru. Her time in the country provided her an opportunity to help implement evidence-based medical care within the health care system and improve her Spanish, which Noble hopes will help her better communicate with future patients. When COVID-19 began to spread globally, Noble returned to the United States to continue her research. 

Earning the award

Noble took off a couple of years after her undergraduate work. She wanted some time to prepare for the rigors of medical school and became involved in international health work in Haiti before applying to VCU’s School of Medicine. Noble said she was impressed with VCU’s opportunities for international work through programs like the International/Inner City/Rural Preceptorship and the Humanitarian Outreach Medical Brigade Relief Effort.

She was excited when she was accepted into the preceptorship program. After her first year at VCU, she traveled to Rwanda with team members from the School of Medicine to help emergency response teams understand how they should invest in medical supplies, human resources and technology.

As Noble approached her third year of medical school, she applied for a fellowship with the Fogarty International Center, which “supports U.S. university consortia to provide collaborative, mentored global health research training opportunities in low- and middle-income countries,” according to the NIH website. 

For mentorship in this program, Noble connected with Lacey LaGrone, M.D., then with the University of Washington. LaGrone, now at University of Colorado Hospital, had previously completed a Fogarty fellowship where she studied barriers to practicing evidence-based surgery in Peru.

Medicine is always changing, and LaGrone wanted to continue her work in Peru and find a way to introduce surgeons in the country to a medical database called UpToDate. The system has access to recent studies and information on 11,800 topics and is used by over 1.9 million clinicians worldwide. It allows doctors to make decisions based on the most up-to-date research, an important project before a global pandemic but even more vital since the onset of COVID-19. 

Furthering evidence-based medicine 

After Noble was awarded the Fogarty fellowship, she and LaGrone worked to introduce Peruvian doctors to UpToDate and reduce the barriers to evidence-based medicine. Noble worked with a team that traveled to various medical facilities and presented information about UpToDate. Their short, one-hour presentation gave surgeons an overview of how to use the database and the potential benefits to patients. 

“We are trying to make learning evidence-based medicine accessible,” Noble said.

Prior to the effort, one of the only trainings available on evidence-based medical practices for surgeons in the country was through the Peruvian General Surgery Society, but that was a multiday seminar. Demand had been low for the training in recent years due to the time commitment.

The training program’s main goal is to improve the practice of evidence-based surgery by introducing surgeons to the database, an easy and effective way to answer clinical questions. These surgeons are also being taught how to use Google Translate because the articles are in English and most of the surgeons only speak Spanish. 

Since returning to the U.S. in the spring, Noble and LaGrone and the rest of their research team have found ways to connect virtually with training participants by communicating with collaborators at partner hospitals in Peru. 

Noble said language was a real barrier for her. She was not well-versed in Spanish prior to the start of the fellowship but made great strides while being immersed in the language. Her desire to go to Peru and work on the UpToDate project was partially driven by a personal goal to learn Spanish and improve her communication with patients. She has relied on a translator when working with Spanish-speaking patients and wants to have the ability to speak with them directly. She believes communication is an important part of being a medical provider.

After graduation next year, Noble hopes to return to Peru to present the research findings to the Peruvian General Surgery Society.

In addition to the UpToDate research project, Noble worked with another team on the ground in Peru to introduce human papillomavirus self-testing to women in remote communities so those who test positive could get the proper treatment to prevent cervical cancer. 

Mary Lee Magee, director of the preceptorship program at VCU, has known Noble since she was a first-year medical student. Magee has been amazed at Noble’s dedication to providing medical care to underserved populations and said that commitment will serve her well.

“The noteworthy motivation and commitment which Helen brings to her academic, research and service roles suggest to me that she will fulfill her expressed goals and build a lifelong career integrating scientific inquiry, advocacy for low-resource populations and communities, and compassionate clinical service,” Magee said. 

“Helen is an exemplary student and a fine example of the type of well-rounded future physician we seek to graduate here at VCU,” said Peter Buckley, M.D., interim CEO of VCU Health System, interim senior vice president of VCU Health Sciences and dean of the School of Medicine. “We’re glad to welcome her back after this fellowship year spent pursuing this incredible international research opportunity.”

A lot of fun

Noble said the work in Peru helped her develop clinical research skills that she is confident she will use throughout her medical career. Her ultimate goal is to be an OB-GYN. She enjoys working in women’s health care and sees that area of medicine as a way to use surgical and interpersonal skills.

She enjoyed her experience abroad. Besides the work, she spent time on the beach and traveled to various parts of the country, including Machu Picchu, before returning to the U.S. Noble said she had more free time in Peru compared to being a full-time medical student in Richmond. It gave her the space to appreciate the impact of her work.

“I have time to reevaluate why I’m doing what I’m doing and see what life as a clinician-scientist can be like,” she said in an interview earlier this year. “[It is] motivating me to think about patient care and systems improvements beyond hospital walls.”