Rachel Marcus ʼ85

Rachel Marcus ʼ85 credits her career trajectory in large part to Jan Braumuller, the now-retired GDS High School Spanish teacher who encouraged her to apply for a public health service program called Amigos de las Américas.

Jan figured this hands-on program in Latin America would appeal to Rachel, an aspiring doctor who loved speaking Spanish. And it did. Through Amigos, Rachel worked for a vaccination program in Paraguay the summer after her junior year. “My time there made me feel a real affinity for Latin America and working with Spanish speakers and people who are indigent,” said Rachel, parent of Abe ʼ18, Saul ʼ20, and Rose ʼ23 Atwood. “Jan’s suggestion showed that she understood me.”

Today, Rachel is a cardiologist and co-founder of the Latin American Society of Chagas, or LASOCHA. The Northern Virginia-based nonprofit helps raise awareness about Chagas, a parasitic disease that mostly affects impoverished communities in Latin America. LASOCHA also tests and treats DC-area immigrants who are at risk for the disease.

Rachel spoke to Georgetown Days about how she became a leading expert on Chagas in the United States and why U.S. doctors need to learn more about it. This interview has been edited for clarity and length. 

How did your summer in Latin America shape your career goals?

During my six weeks in Paraguay, I helped vaccinate people for measles and yellow fever in very rural, poor communities. Sometimes, we’d have to hike three hours to get to our outpost. It was eye-opening. I came back with a new appreciation of what poverty looks like and realized that I really enjoyed working in a third-world environment where I could make a difference. 

My parents are both physicians, and I wanted to be a doctor for as long as I can remember. So I went to college knowing that I would apply to medical school. I majored in Political Science with a focus on Latin American issues so I could better understand the region. My goal was to become an academic tropical medicine expert doing research in the developing world. I was hopeful that I would end up living in Latin America someday. 

Did you ever return to Latin America?

After graduating from medical school at Stanford in 1994, I did three years of residency (two at Brigham and Women’s Hospital in Boston and one at Stanford) and then a three-year fellowship in cardiology at Stanford. I did two rotations in Brazil during that time.

In Brazil, I met a physician who was an expert in Chagas disease. He’d been working in the same area of Brazil where Carlos Chagas, a Brazilian physician, first described what would come to be known as Chagas disease. He connected me with a cardiologist there, and I shadowed her for several weeks. I learned Portuguese along the way, and I loved the entire experience. I came back with more knowledge about Chagas than most U.S. physicians. But it was a niche knowledge, and I didn’t expect to do anything with it. 

How do people get Chagas disease?

The disease is caused by a parasite that is mostly transmitted to people by triatomine insects, known as kissing bugs, vampire bugs, or cone-nose bugs. It can also be passed from mother to baby during pregnancy and through contaminated food. The earlier you treat the disease the more likely you are to cure it. But many people don’t know they are infected because symptoms may not show up for decades (if at all), which is why screening for the disease is crucial. Chagas can lead to lethal heart problems and intestinal damage.

How prevalent is Chagas disease in the United States?

If you went to medical school in the U.S., you were probably taught about it as a disease you’d never see unless you went to Latin America. That was pretty true until millions of people started to move from endemic countries to the United States. Certain pockets of the U.S. now have many Latin American immigrants who are at risk for the disease, and the Washington, DC area immigrant community is at the highest risk in the country. The CDC estimates that more than 300,000 individuals in the United States have this parasitic infection.

But the community of at-risk Latin American immigrants has a tough time advocating for itself because most of the people affected do not speak English, and they tend to be poor and uninsured. A significant portion of them are undocumented. Insurance programs and policies for the indigent vary from state to state, so there’s no coherent strategy for dealing with this problem. On top of that, Chagas disease is tough to diagnose and treat, and many U.S. doctors still don’t know much about it.

How did you get involved in screening for and treating the disease?

After my residency, I joined a practice on K Street working with two senior cardiologists. It was a wonderful practice that allowed me to connect with many fascinating people in a real mom-and-pop kind of atmosphere. But I was not working with the population of patients that I went into medicine to serve. So I contacted Dr. Peter Hotez, a leading expert on neglected tropical diseases [and chair of the microbiology at the George Washington School of Medicine at the time] to discuss my situation. I think it was Dr. Hotez who suggested I work with the at-risk Latin American immigrant population in Northern Virginia. 

I left my practice in 2012 and threw myself into reading everything I could about Chagas disease. I spent hours on the internet printing out papers and speaking to anyone I could about it. A couple of months later, I met Jenny Sanchez, who would become the co-founder of LASOCHA.

Why did you and Jenny launch LASOCHA?

Jenny is a microbiologist and a Bolivian immigrant who wanted to get screened for Chagas when she was pregnant with her son. She was surprised to find that her doctor in Northern Virginia had not heard of the disease, and she figured that thousands of people living in Northern Virginia faced a similar challenge. She wanted to start a nonprofit to deal with this issue and got connected with Doctors Without Borders, and it was Doctors Without Borders that connected Jenny and me. We created LASOCHA in 2013. [Jenny is currently president and Rachel is medical director of the group.]

What has LASOCHA achieved in the past decade?

We’ve screened about 2,400 people in the DC metropolitan area for Chagas disease, and 4% of them tested positive. We’ve also collaborated with many experts, healthcare organizations, and even embassies to help achieve our goals. For instance, we partnered with Johns Hopkins University from 2016 to 2018 to help them perform a large-scale screening study of immigrants, and we inherited those patients for our clinic. 

I also spend a lot of my time raising awareness within the medical community. I’ve written several papers on the topic, and I regularly speak at academic conferences, nationally and internationally. Generally, I see patients once a week for free at our clinic. That’s in addition to my day job at MedStar Health, where I am a heart ultrasound specialist. I run the program at the MedStar hospitals based in Baltimore. 

What is your biggest challenge in keeping this organization running?

Everything we do for LASOCHA is done on a volunteer basis, and we rely on the generosity of so many different partners to keep the operation running. Tu Family Medical and Vision Clinic in Falls Church lets me use its clinic space rent-free to see patients. Inbios International donates rapid test kits. Dr. Robert Gilman at Johns Hopkins lets us use some of his cardiac testing equipment. Slowly but surely, we’re making progress. But we need more financial support. We rely on donations for testing supplies, educational materials, supplies for our cardiac testing machines, and malpractice insurance.

Learn more about LASOCHA's work and needs at https://lasocha.org/