Fleeing a Revolution, Becoming an Oncologist

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Nicaragua, situated between Costa Rica and Honduras, is the poorest country in Central America. Following the U.S. occupation in 1912, the Somoza family began a brutal political dynasty that would end in 1979 during the bloody Nicaraguan Revolution. 

Marcela G. del Carmen, MD, MPH

Marcela G. del Carmen, MD, MPH

Marcela G. del Carmen, MD, MPH, Chief Medical Officer of the Massachusetts General Physicians Organization, was born in Managua, the capital of Nicaragua. “In 1979, when I was 10 years old, my family moved to the United States to escape the revolution. We settled in Seattle, Washington, but we moved around quite a bit and finally settled in Miami, where I went to high school,” said Dr. del Carmen. 

A Role Model in the Family 

DR. DEL CARMEN said her first exposure to medicine was through her maternal grandfather, who was a urologist. “My grandfather trained at Johns Hopkins in the late 1940s, and at a very early age, I was very impressed by what he did. Before we left Nicaragua, when I was 8 or 9, I had already decided I wanted to pursue a career in medicine,” she said, adding, “My grandfather began his career as a urologist, but when he was in his 50s, he retired from clinical practice and went into public health, which was also very formative in my career path and interest in public health issues such as disparities of care in oncology.” 

After graduating high school, Dr. del Carmen entered Emory University in 1991, primarily because she was attracted to the school’s basic science programs. “As I’d made my decision to become a doctor, I wanted a school with a good premed program, and Emory fit the bill. But I also wanted to get a good liberal arts education, and at Emory, I ended up double majoring in biology and also in Spanish literature, with a minor in Latin American and Caribbean studies. I was very happy with my education at Emory,” shared Dr. del Carmen. 

Johns Hopkins: Road to the OR 

AFTER GRADUATING Emory University with her BS, summa cum laude, Dr. del Carmen entered Johns Hopkins University in 1995. “When the time came, I applied to medical schools across the country and was fortunate enough to be accepted to Johns Hopkins, where my grandfather went. During the middle part of my first year, my mother’s closest friend from Nicaragua had a son who developed leukemia and was treated at Johns Hopkins. Seeing how a disease like leukemia affected the boy and his whole family peaked my interest in oncology,” said Dr. del Carmen. 

Dr. del Carmen’s first experience in the OR, witnessing a cesarean section, had a profound effect on her career path. “I decided that no matter what I did in medicine would ultimately have to include time in the OR. I had a hard time deciding between obstetrics/gynecology and general surgery. However, a resident suggested I spend more time doing gynecologic oncology. So I began the obstetrics/gynecology program at Johns Hopkins, with a goal of becoming a gynecologic oncologist,” said Dr. del Carmen. 

“One thing that’s special about gynecologic oncology is that we provide continuity of care because we’re not only the surgeons; we also deliver chemotherapy as well.”
— Marcela G. del Carmen, MD, MPH

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After obtaining her MD from Johns Hopkins, Dr. del Carmen did her gynecologic oncology residency at Hopkins. “After my residency, I came up to Massachusetts in 1999 to do a 3-year fellowship at Massachusetts General Hospital [Mass General]. The first year was spent in the basic science laboratory doing research in ovarian cancer. I spent the next 2 years in the clinic learning how to become a radical pelvic surgeon. I also had to deliver chemotherapy to patients with gynecologic cancers,” explained Dr. del Carmen. 

On to Mass General 

AFTER HER fellowship, Dr. del Carmen went back to Johns Hopkins for a year, serving as Assistant Professor in Gynecology and Obstetrics. Then she returned to Mass General and also pursued a degree in public health at the Harvard School of Public Health, earning her MPH in 2006. 

Since her return to Mass General, she has served on the Combined Residency Education Committee and co-chaired the Diversity Action and Implementation Advisory Committee. In 2013, Dr. del Carmen’s colleagues recognized her dedication to providing compassionate care when she received the Massachusetts General Physicians Organization (MGPO) Brian A. McGovern, MD, Award for Clinical Excellence. In 2016, Dr. del Carmen was named Chief Medical Officer of the MGPO. In that role, she leads over 3,200 MGPO physician members. 

A Day in the Life 

ASKED TO describe her current work, Dr. del Carmen responded: “I split my time between the ambulatory center and the operating room. I usually start my day between 5:30 and 6:00 AM with rounds in the inpatient unit. Then I move to the office, spending the next part of the day seeing a variety of patients. I could see a patient with newly diagnosed ovarian or endometrial cancer or one who is going through treatment for a previously diagnosed malignancy. I also see patients who are doing well and come in for follow-up visits as well as those who have been diagnosed with recurrent cancer. So my day is quite varied and challenging.” 

“My schedule is a good mix of surgical and medical care, which is very rewarding. One thing that’s special about gynecologic oncology is that we provide continuity of care because we’re not only the surgeons; we also deliver chemotherapy as well. One of the highlights of my time in the OR, where I perform radical pelvic and abdominal surgeries on patients with gynecologic malignancies, is getting to teach fellows and residents in training. Being around all of that energy of the younger generation of oncologists is very stimulating,” said Dr. del Carmen. 

Public Health Work 

“MY INTEREST in public health was largely formed from my experiences at Johns Hopkins managing patients from underserved populations, many of whom were from the African American community. I learned about the issues they faced when trying to negotiate their way through a complex medical system. As an immigrant from a poor country, the issues of health-care disparities are especially meaningful,” said Dr. del Carmen. 

“In the research I do, I look at how receipt of care is allocated in the United States, and we know there is a great disparity in cancer care outcomes between white patients and African American, Native American, or Hispanic patients. It is a very complicated issue, some of which is driven by access to care and other socioeconomic challenges. My commitment in research has been looking at large databases to identify exactly where the disparities exist and then develop strategies to help resolve the underlying issues driving the disparities,” said Dr. del Carmen. 

“As an immigrant from a poor country, the issues of health-care disparities are especially meaningful [to me].”
— Marcela G. del Carmen, MD, MPH

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Closing Thoughts 

ACCORDING TO Dr. del Carmen, the future of oncology is promising and will be led by exciting new targeted therapies and personalized care. “I think we are gaining great knowledge about the drivers of molecular behavior that are resulting in new targeted therapies we didn’t have a few years ago, which demonstrates how quickly the advances are happening. Undoubtedly, we’ll learn lessons along the way about the best way to employ these drugs in combination,” said Dr. del Carmen. 

She continued: “We also have a health-care system that is under duress, so we have a challenge ahead in figuring out how best to allocate our precious resources. Moreover, the side effects of these new drugs are still not completely understood, and they will offer yet another challenge to our supportive care system.” 

“One worry of mine is as we advance the frontiers of oncology is that we need to be mindful as a society that we don’t leave our vulnerable patients in underserved areas behind. I’m fortunate to be able to use my background and education in public health to initiate pilot studies that will help us better understand the needs of large populations of patients, not just the patients in our office,” concluded Dr. del Carmen. 

Dr. del Carmen is an avid reader and traveler. “Every year I make a point of taking a trip somewhere in the world. It’s a good way to disconnect from my space in medicine and connect with different people and cultures.” ■

DISCLOSURE: Dr. del Carmen reported no conflicts of interest.