Last December, Cecilia Sara Alcala, a PhD Candidate at the Tulane University School of Public Health and Tropical Medicine, was listed as one of 13 Students Who Rocked Public Health in 2019 for her work assessing pesticide literacy of women in Suriname. Here, she describes her efforts in more detail. Follow along each month as we profile all 13 Students Who Rocked Public Health 2019.

I was born and raised in Brooklyn, New York, to immigrant parents from Haiti and Trinidad and Tobago. At birth, I was diagnosed with a congenital heart defect called Tetralogy of Fallot. As a child, I would look forward to routine pediatric cardiology visits because I was able to ask about the importance of health, public health research, and cardiology. My doctor would explain that there are multiple factors leading to the development of this condition, including environmental and hereditary. Consequently, my general research interests are driven by personal experiences and focuses on exposure to environmental factors and their association with maternal and infant health outcomes.

As an Association of Schools and Programs of Public Health (ASPPH) Environmental Health Fellow at the US Environmental Protection Agency (EPA), I had the opportunity to utilize my skills to develop an assessment of the literature on environmental chemicals in breast milk and infant formula and infant dietary exposures to environmental chemicals and infant/child health. I was also able to analyze the National Health and Nutritional Examination Survey (NHANES) data to estimate PCB concentrations in US women based on their breastfeeding history. My experiences as a fellow provided me with the opportunity to work with leading experts in the field and helped narrow the direction of my research interests. As a PhD Candidate at the Tulane University School of Public Health and Tropical Medicine (Tulane SPHTM), I have been able to strengthen my understanding and importance of environmental health literacy (EHL), specifically among vulnerable populations in order to inform effective communication and interventions.

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Currently, I am conducting my dissertation research evaluating pesticide levels of pregnant women, assessing the knowledge, attitudes, and behaviors (KAB) pertaining to pesticide use, and identifying the primary source of exposure among women of reproductive age, as a UJMT Fogarty Global Health Fellow in Suriname. The study population is a part of the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort. The CCREOH is an environmental epidemiologic cohort study created to assess the impact of environmental exposures on 1000 maternal- child dyads recruited during pregnancy and followed prospectively through four years of age in Suriname. Suriname is an upper middle- income Caribbean country located in South America, where pesticides are used for agricultural production and pest control. Pesticide usage is primarily used in the districts of 1) Paramaribo, the capital of Suriname and an urban area; 2) Nickerie, a rural area, known for its rice production; and 3) the interior, a rural area, known for the rainforest. Residential uses of pesticides are prevalent, and commonly used in tropical regions, household insecticides, pet sprays, and mosquito repellent nets, mostly in Paramaribo. Agricultural pesticides are used for the large-scale rice production in the district of Nickerie, a rural area. There is limited information on pesticide usage in the interior, however, training and research are currently underway. As a result, the population of Suriname may be exposed to pesticides which could result in adverse health outcomes, especially in vulnerable populations such as pregnant women and children. Preliminary urinary analyses indicate pregnant women in Nickerie and Paramaribo CCREOH sub- cohorts are exposed to pesticides from the following three pesticide classes: phenoxy acid herbicide, organophosphate insecticides, and pyrethroid insecticides, which could lead to adverse neurodevelopmental outcomes.

Working and living in Suriname has been an opportunity of a lifetime. As an environmental health professional with roots in the Caribbean, I am passionate and determined to improve KABs pertaining to environmental chemicals and maternal and child health outcomes through effective interventions to improve health outcomes. Being able to start my journey of improving EHL and exploring the impact of pesticides within the maternal and infant population in Suriname has opened my eyes to importance of cultural competency while executing research. It has been a joy learning the culture and a new language, Dutch.

Naturally, a PhD journey would not be without its challenges. Conducting research internationally has had its obstacles, from applying and receiving IRB approval from both my home institution and from Suriname to learning cultural norms. The best advice I can give to other students pursuing research abroad is to create a realistic project timeline and ensure you are communicating with your committee both in the US and abroad to ensure that everyone is on the same page. Lastly, your journey within the field will be a continuous jog and not a sprint. It will have many obstacles and triumphs, remember to stay true to yourself through it all and continue to persevere.

Read About More Students Who Rock:

• Students Who Rocked Public Health 2019
• Students Who Rocked Public Health 2018
• Students Who Rocked Public Health 2017
• Students Who Rocked Public Health 2016
• Students of Public Health: Student Voices and Profiles