Zach Gentry, M.D., is breaking new ground as the inaugural Global and Rural Health Fellow for the Department of Obstetrics and Gynecology. His journey into global health began when UAB introduced this fellowship within the past two years, offering OB/GYN residents an opportunity to engage in international medical research and intervention. For Gentry, the opportunity was too compelling to pass up.
Cervical cancer screening in Quito, Ecuador
Gentry’s fellowship is centered around cervical cancer screening research in Quito, Ecuador. Working in collaboration with the Universidad San Francisco de Quito, a private medical school with a great commitment to underserved communities, his research is deeply embedded in the public health system. Most cervical cancer screenings in Ecuador occur at public health centers, known as “centros de salud,” which are staffed by midwives and family medicine physicians. These centers are responsible for conducting pap tests and initial screenings but face significant barriers for patient follow-ups and access to advanced care.
During his time in Quito, Gentry interviewed 27 healthcare professionals, including OB/GYNs and public health officials, to assess the state of HPV vaccination, cervical cancer screening, and follow-up and the challenges associated with these efforts. A major issue identified was the delay in receiving pap test results, which can take up to six months. Additionally, HPV testing is not widely available in public health centers despite its growing evidence as a preferred primary screening method worldwide.
Advancing screening and treatment accessibility
Gentry’s research aims to generate recommendations for Ecuador’s public health administration to improve screening processes and follow-up care. Upon returning to Quito for the second half of his fellowship, he will finalize his data analysis and collaborate with physicians and policymakers to propose feasible interventions.
One of the most promising initiatives under development is a training program to expand colposcopy access. In Ecuador, colposcopies—the next step after an abnormal pap test—are typically performed only at hospitals, creating significant travel and logistical barriers for patients in rural areas. Inspired by Alabama’s “OPERATION WIPE OUT” initiative, which trains nurse practitioners to perform colposcopies in underserved regions, Gentry’s project aims to train midwives in local health centers to perform this procedure, thereby increasing accessibility and expediting follow-up care.
The path to global impact
Gentry’s decision to conduct his fellowship in Ecuador was guided by both personal and professional considerations. As a Spanish speaker, he wanted to immerse himself in a Spanish-speaking country. Additionally, his future career in gynecologic oncology made cervical cancer prevention an ideal focus for his research. Leveraging connections established by UAB OB/GYN faculty, such as Brian Gleason, M.D., and Isabel Scarinci, Ph.D., he initiated this project while building on existing relationships with Ecuadorian medical institutions.
His work aims to increase early diagnosis rates and treat precancerous lesions before they develop into invasive cancer. The major obstacles remain access to vaccinations and screenings and overcoming public misconceptions surrounding the HPV vaccine. In many communities, HPV vaccination is stigmatized due to its association with sexual activity, leading to hesitancy among parents and young women.
A lasting legacy for the fellowship
Gentry’s fellowship will conclude in July, after which he will begin a gynecologic oncology fellowship at Ohio State University. However, his impact on global health at UAB will continue. While the focus of each fellow’s work may evolve, UAB OB/GYN remains committed to strengthening its global health program, advancing sustainable international collaborations, apply lessons learned in the global settings to rural Alabama, and train OB/GYN physicians in launching their academic careers.
“The ultimate goal of this fellowship is to provide OB/GYN physicians who want are committed to pursuing a career in academic medicine with a strong foundation in research in low-resource settings,” said Isabel Scarinci, Ph.D., vice-chair for Global and Rural Health in the Department of OB/GYN and Global and Rural Fellowship co-director.
Reflections on a transformative experience
For Gentry, the most rewarding aspect of this fellowship has been working alongside dedicated healthcare providers in Ecuador.
“Working with the amazing physicians and midwives who are facing these obstacles daily has been incredibly rewarding,” said Gentry.
He has witnessed firsthand how these professionals navigate immense challenges such as shortages of essential supplies and difficulties in patient follow-ups. He hopes to amplify their voices through his research and implement practical, locally-driven solutions to improve cervical cancer prevention efforts.