Health Justice Scholars Present Capstone Research Addressing Gaps in Health Equity

Posted in News Stories  |  Tagged health justice, Health Justice Alliance, Health Justice Scholar Track, Health Justice Scholars, Health Justice Week, longitudinal academic track, medical education, student experience

(March 21, 2025) — Fourth-year medical students who chose to deepen their understanding of health disparities by enrolling in the Health Justice Scholars longitudinal academic track presented their final research projects during the annual Health Justice Week, a collaboration with the Health Justice Alliance (HJA), a medical-legal partnership between Georgetown’s medical and law centers.

“When I was applying to medical schools, Georgetown was my top choice because of the school’s involvement with policy work and advocacy,” said Nadia Samaha (M’25), a Health Justice Scholar.

Expanding Access to Care for Rural Residents

Despite her access to, and understanding of, the health care system as the daughter of a surgical oncologist in Los Angeles, Amanda Foshag (M’25) developed an awareness of how difficult it can be for people to access health care, especially specialists, in rural settings.

“I spent a lot of time visiting my grandparents growing up, who lived on a farm outside of Columbus, Ohio, and saw firsthand how difficult it could be to see a doctor when having medical issues,” said Foshag.

Those memories stuck with Foshag. For her capstone project, she decided to conduct a literature review looking at different studies on morbidity and mortality for patients with cancer diagnoses living in rural areas as part of a broader evaluation of existing legislation to combat the issue.

Foshag recounted how many of the studies examined distance to the closest major hospitals. “Cancer treatment is difficult even if you live less than a mile from a hospital,” said Foshag. “Radiation treatment for lung or breast cancer could require visiting a hospital every day for eight weeks, which requires a lot of balancing of family and work commitments, but it is exponentially more cumbersome if you add a two- to three-hour drive on top of it.”

Foshag explored literature suggesting that patients who received a shorter, more intensive radiation therapy did the same, if not better, than those with standard, longer treatments, which could reduce the burden to access care for oncological services for rural patients.

“The House introduced a bill in 2023 that addresses reimbursement plans that would not penalize physicians who prescribe the shorter, more intensive treatments,” said Foshag. “The bill would also create one gross fee for patients and remove any conflict of interest for physicians.” Her research also included a discussion on a bill that would cover the transportation costs for rural patients in accessing specialized care.

“The Health Justice Scholars Track is so beneficial in learning how policy is actually enacted and how lobbying works,” said Foshag. “I hope to use this knowledge as a physician to engage with policymakers at the highest level to stay involved in continuing to expand access to care for rural residents.”

Understanding the Cost of Financial Toxicity in Cancer Care

Nadia Samaha (M’25) has long been committed to addressing health disparities. She took a dedicated research year between her third and fourth years of medical school to study financial toxicity under the mentorship of Leila Mady, MD, PhD, MPH, an assistant professor at Johns Hopkins School of Medicine.

The two focused their research on head and neck cancer patients who face worse mortality outcomes when the financial burden of care is high.

“I worked with Dr. Mady in conducting mixed-methods research to assess the financial burden that patients and their caregivers face due to cancer treatment. Beyond administering financial toxicity surveys and identifying risk factors, we interviewed patients to better understand the underlying drivers and explore future interventions,” said Samaha.

Samaha described financial toxicity as the financial strain and emotional stress that patients and their families experience due to the cost of medical care. “It includes not only immediate costs like deductibles and copayments, but also taking time off work, transportation expenses and behavioral shifts in spending — such as cutting back on food, housing or clothing,” she said. “Financial toxicity also doesn’t end when treatment does. For many, the burden continues well into survivorship, affecting recovery, independence and the ability to return to work. This is especially true for head and neck cancer patients, who often face long-term difficulties with speaking, breathing, and swallowing, necessitating ongoing care, specialized suppliers and extended surveillance.”

The next phase of their research focuses on evaluating interventions to reduce financial toxicity. These could include expanding access to dedicated patient financial advisors, leveraging telehealth to reduce travel and missed work, and promoting cost transparency from both insurers and institutions so that patients can anticipate and prepare for expenses. They also aim to improve financial literacy through education for both patients and health care providers. Samaha emphasized the importance of advocacy in the health policy space, as well as leveraging medical-legal partnerships to support patients facing the downstream impacts of financial hardship.

“This research experience, along with the tools I’ve gained from the Health Justice Scholars Track, will shape the kind of physician I become,” said Samaha. “It has taught me to approach patient care holistically and to integrate financial health into my practice. I hope to not only save lives through the treatment I deliver, but also support long-term quality of life beyond the hospital setting.”

Using Nutrition Screenings to Address Food Insecurity

Before starting medical school at Georgetown, Alice Bell (M’25) spent a year teaching in Washington, D.C., schools through AmeriCorps. She remembered that students often would show up in her second-grade classroom without having eaten breakfast.

“Not having breakfast really impacted the students’ ability to focus and learn,” said Bell.

As a D.C. native, Bell wanted to focus on the area for her research in the Health Justice Scholars Track. She worked at MedStar Georgetown health centers located in two local public high schools that provide a range of care for students free of charge, from regular immunizations to mental health counseling.

“While in the clinics, I would work with a care team to screen for food insecurity with teenagers who visited the clinic,” said Bell. “We would ask patients questions related to noticing if their caregivers are struggling to put on the table or having trouble in accessing charitable food.”

If students responded that their family had difficulty in accessing food regularly, then they would be referred to resources to help them gain greater access. In the Washington, D.C., region, 37% of households experience food insecurity.

“A significant barrier to addressing food insecurity is really awareness,” said Bell. “Many families are not aware that they qualify for programs where free meals are provided.”

Bell believes that effective intervention around increasing awareness can go a long way toward addressing food insecurity

“The health justice track helps me stay focused on things beyond the clinic, like caring for the Greater D.C. community in a holistic way, which is what drove me to pursue medicine,” said Bell. “And Georgetown is a great place for medical students interested in improving health equity and community health because of cura personalis, care for the whole person, which encourages doctors to think about everything that goes into treating a patient.”

Heather Wilpone-Welborn
GUMC Communications