Doctoral Student Examines Resilience through a Personal Lens

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Ruth Gaelle St. Fleur grew up in Haiti, where she had to overcome several obstacles. Now she is exploring the trait of resilience in cancer survivors at Sylvester Comprehensive Cancer Center as part of her doctoral research

Ruth Gaelle St. Fleur’s life has been a training ground in resilience.

Ruth Gaelle St. Fleur.

At the age of 14, St. Fleur, her four siblings, and their parents escaped from their home in Haiti as it collapsed in the debilitating 2010 earthquake. St. Fleur’s family of seven spent the next six months shifting between a relative’s home and a one-bedroom rental. At times, they even slept in the family’s truck.

Despite their struggles, her parents always stressed the importance of education, and that was not lost on their youngest daughter. Two years after losing her home, St. Fleur won a scholarship to finish high school in Hong Kong. She left Haiti for a place where no one looked like her, and no one spoke Haitian Creole or French, the only languages she knew. Although it was a shocking transition, St. Fleur thrived, graduated, and went on to earn a full scholarship to Brown University.

She is now one of the few students to go straight from an undergraduate program into the University of Miami’s doctoral program in Prevention Science and Community Health. St. Fleur is also the only Haitian citizen on a student visa enrolled at the University this semester. Her scholarship and need recently helped St. Fleur win an emergency student award from the Institute of International Education.

And although she only realized it recently, St. Fleur said her upbringing inspired her to study the quality of resilience. “There are some extremely resilient people in Haiti,” she said. “It’s the only way to survive.”

The Impact of Resilience

For her dissertation, St. Fleur is examining how resilience can impact the quality of life and physical health of cancer survivors, as well as their caregivers. Meanwhile, she is doing her best to brighten the spirits of her mother, who is being treated for cancer-related issues in Haiti. Unfortunately, St. Fleur has not been able to visit home for more than two years because of the violent crime engulfing the island nation. Then in August, while her mother was recovering from surgery in a hospital, all the doctors and nurses fled the building when a second earthquake rattled the ground. Her mother has since returned home, but now St. Fleur worries for her family’s safety from the nation’s gangs.

“The trait of resilience exemplifies Ruth to her very core, but I don’t think she always sees it,” said Sara St. George, P.D., with Sylvester Comprehensive Cancer Center. St. George is an assistant professor in the Department of Public Health Sciences at the Miller School of Medicine who also serves as St. Fleur’s primary mentor. “Ruth is incredibly resilient.”

According to St. Fleur, resilience is either a trait that someone has naturally, like one’s ability to be optimistic, or resilience can be learned through time and experience. For example, St. Fleur said that some people who receive a cancer diagnosis try to look for the positive consequences of the diagnosis, in what is called “benefit finding.” This is something that people who have high resilience may do automatically, but it can also be taught, according to St. Fleur.

To measure the effects of resilience, St. Fleur analyzed physical and mental health data on survivors of breast and colorectal cancer, by focusing on a biomarker of inflammation that often increases with stress. St. Fleur said she discovered that people with more resilience — whether it is a natural trait, or it is learned — often fare better when battling cancer.

Targeting Inflammation

“Resilience affects how survivors and caregivers cope with cancer, because it actually helps decrease inflammation in survivors and caregivers,” she said. “This is a good thing because in survivors, inflammation affects or is related to tumor progression. And in caregivers, stress also causes inflammation, so even without cancer, this could increase the risk of them developing other conditions, like heart disease.”

Further, St. Fleur learned that when a person has lower levels of resilience at a cancer diagnosis, often they have a larger capacity to learn resilience strategies. Therefore, St. Fleur stated that her research could help cancer intervention programs tailor therapy to a person’s individual level of resilience, so it is most impactful for them.

“We need to figure out what interventions work best for people based on their mental state right after diagnosis,” she said. “When it comes to coping with cancer, one size does not fit all. More tailored behavioral and psychosocial interventions are needed for cancer survivors, because providing them with effective coping strategies will lead to better physical and mental health outcomes for them, as well as greater rates of survival and a lower risk of recurrence in the long run.”

Ideally, St. Fleur will submit three papers for publication about her research before her graduation in May. She is also currently applying to post-doctoral programs, where she hopes to delve into how culturally informed resilience strategies could be even more effective, and how discrimination can affect behavior, quality of life, and immune system function in cancer survivors, particularly in minority communities.

Collaborations Will Continue

While she may have to say goodbye to her mentee this spring, St. George anticipates many future research collaborations with St. Fleur because she feels so confident in her mentee’s abilities. In fact, St. George said she often shares her own research ideas and papers with St. Fleur for feedback.

“Ruth’s biggest strength is that she has an uncanny ability to think up strong, complex research questions and execute them through sophisticated analyses,” said St. George, whose research focuses on lifestyle interventions related to cancer and are often geared toward the Hispanic community. “She never ceases to amaze me with how creative she can be, and she is also a great writer and a confident speaker.”

Despite her family’s strife in Haiti, St. Fleur said she loves studying in Miami because she feels closer to home and is fortunate to have mentors like St. George and psychology professor Michael Antoni, Ph.D., director of the Center for Psycho-Oncology Research — both affiliated with the Sylvester Comprehensive Cancer Center — who have guided and supported her research. She is also grateful to have partners in the Office of International Students and Scholar Services, who nominated her to receive the recent award.

“I’ve been very lucky to have people who see the potential in me and want to create opportunities for me, because I know not everyone has that,” she said.

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