Standing Up for Women and Children:
Special Web Feature

In this issue, we are proud to feature stories on two graduates-turned-activists who are making a difference in the lives of women and children. Radiologist Juliette Engel, M.D. ’74, is fighting human trafficking and other social ills in Russia and the U.S.; see the Q & A. And Melissa Smith, M.D. ’87, Res. ’91, after years of work in the developing world, is about to publish a health action guide for women and their advocates. 

Q & A With Juliette Engel: No Turning Back

Taking Action for Women’s Health: Melissa Smith


No Turning Back: Alumna and Human Rights Activist Juliette Engel

“I was able to take the medical model I learned at UW and apply it to the way we run our Russian NGOs,” says alumna activist Juliette Engel, M.D. ’74, pictured here in Moscow. “As a result, we are more results-oriented, move at a faster pace, and form community coalitions that include local government agencies and the people we are benefitting.” Photo courtesy of Juliette Engel.

Radiologist-turned-activist Juliette Engel, M.D. ’74, a former UW assistant professor in the Department of Radiology, drastically changed the course of her life in 1992. She sold a successful diagnostic ultrasound practice in Bellevue, Wash., to establish the MiraMed Institute, a nonprofit that sought to improve obstetric care in Russia and now focuses on advancing human rights for woman and children. She went on to co-found two non-governmental organizations to further her vision for social justice in Russia: the Angel Coalition and Women and Children First. Below she answers a few questions about her humanitarian work.

What inspired you to sell your medical practice to work with women and children in Russia?

In 1990, I was invited to what was then the Soviet Union to present a paper on diagnostic ultrasound. While I was there, I had the opportunity to tour their maternity hospitals. I was expecting modern facilities, but it was a nightmare — a third-world situation. There was no soap or running water, no gloves, no antiseptics, antibiotics or pain medication. When I came home, I just couldn’t stop thinking about what I had seen. At first, I helped sponsor trainings for Russian doctors in Seattle and facilitated equipment donations, and then I just kept getting more involved. It wasn’t long before I discovered that one-third of Russian babies were abandoned to orphanages and that many of these children were sold into slavery. Knowing that, I couldn’t turn back.

How did you discover that human trafficking was occurring?

I was delivering a truckload of winter clothes to an orphanage in February 1997. There were exactly enough coats to give one to each child. By morning, the coats had been distributed, and the children were wearing them on their way to school. I looked in the closet and found 18 coats still hanging there — all for teenaged girls. When I asked where the girls were, I was told they had gone on a picnic to Finland. “In the middle of winter?” I asked. The response: “No, they went last September and never came back.”

Pictured here are several employees of the Angel Coalition, one of the organizations Juliette Engel, M.D. ’74, co-founded to fight human trafficking. Photo courtesy of Juliette Engel.

In what way did UW Medicine prepare you for your humanitarian role?

I was able to take the medical model I learned at UW and apply it to the way we run our Russian NGOs. As a result, we are more results-oriented, move at a faster pace, and form community coalitions that include local government agencies and the people we are benefitting. I came from a model where it was important to be a patient’s advocate, so we become the advocates for the children and women we are helping.

What do you enjoy most about your work?

I have been doing this long enough that I appreciate the follow-up stories. I was feeling particularly discouraged one day about a year ago when I received a letter that had been posted in a tiny Russian village near the Finnish border. It was a note from a young couple named Katya and Denis who had been in a local orphanage together. Through my efforts, they both went on to attend educational institutes in St. Petersburg. They are now married, working as teachers, and have two children. If I achieved nothing else, that alone would make it all worthwhile. 

What are your future goals for your human rights work?

Right now, my focus is writing stories and publishing books to get people to accept that human trafficking is happening, even in the United States.

Learn more about Engel’s work at


Taking Action for Women’s Health: Melissa C. Smith, M.D. ’87, Res. ’91

By Sarah Shannon and Lily Walkover

A group of young indigenous women leaders show off their new copies of Where Women Have No Doctor after a reproductive health training led by Melissa C. Smith, M.D. ’87, Res. ’91, in Oaxaca, Mexico. Photo courtesy of Melissa Smith.

There are moments when the world answers our questions.

For UW School of Medicine alumna Melissa Smith, one of those moments came in 1979, while she was working in a bush village clinic in Liberia. She was deciding between studying public health and going to medical school, trying to figure out what kind of education would allow her to be most effective. Her moment came when a child died in her arms of malnutrition.

“I realized I wanted to do both. I wanted to have tangible medical skills to offer to a community,” says Smith. “But I also wanted to work together with community members to understand the root causes of health problems, to find solutions, and for them to be able to take action themselves to solve those health problems. That was my vision going into medical school.”

While at the UW School of Medicine, Smith was awarded a fellowship that supported travel to and from Nicaragua during her first three years of medical school. Later, she took a leave of absence to spend more time in Nicaragua, part of a program to promote international cooperation and strengthen primary healthcare. The School gave her the flexibility and support to make this possible, and she spent a year training health workers and midwives, work that she continues today.

Smith is seen here training community health workers during the Contra war in Nicaragua in 1988, using Donde No Hay Doctor. Photo courtesy of Melissa Smith.

Smith’s work in Liberia and Nicaragua also introduced her to Hesperian Health Guides, a non-profit public health publisher. In Liberia, Hesperian’s Where There Is No Doctor, a simple self-help book designed to allow people to care for themselves and their community when they cannot access the medical system, was Smith’s only reference book. In Nicaragua, she used the companion title Helping Health Workers Learn to run her training programs, with Doctor as a textbook.

In the early 1990s, while training health workers in Guatemala, Smith met a group of Hesperian editors who were planning a women’s health book. She helped to field test content for the book with the women she was training, and eventually became the medical editor for Where Women Have No Doctor, published in 1997. While field testing chapters on safe pregnancy and childbirth, many women told her how useful it was to have this kind of health information available. What they also needed, they added, was information about how to take action on the root causes affecting women’s health: cycles of inequality and violence that put men’s needs first. Smith brought up the idea of a companion book of strategies for community organizing, but without funding, the project fell to the wayside.

A decade later, more than 200,000 copies of Where Women Have No Doctor had traveled around the world; it had been translated into 27 languages, and it had done a great deal of good. An Urdu translator from Pakistan shared the following story. “The first 1,000 copies went out like hotcakes,” wrote the translator. “Women’s groups and NGOs [non-governmental organizations] all over Pakistan are asking for more. An NGO leader from the mountain village of Hazara wrote, ‘One night a village woman’s labor pains started. The nearest health unit was seven hours away. We tried the methods and illustrations of the book, and she gave birth to a baby girl. The book saved that woman’s life.'”

Women in Kibera, Kenya, facilitate activities from draft chapters of the women’s action guide in order to gather feedback from community members. Similar activities took place in over 20 countries. Photo courtesy of Melissa Smith.

Finally, the moment was right to start planning a women’s action guide. With support from the School of Advanced Research in Santa Fe, a global steering group with representatives from North and Latin America, Africa, the Middle East and South Asia was assembled.  

Then the work began. Over the last four years, Smith has collaborated with Hesperian writers and editors, the steering group and grassroots organizations in more than 20 countries, building the book suggested years before by those community health workers in Guatemala.

Health Action Guide for Women and Girls will include activities and strategies to help health promoters tackle difficult discussions about sexuality, family planning, safe motherhood, unsafe abortion, HIV and violence against women, among other topics. It is designed to be useful for a range of community activists and health promoters, and while it is focuses on the experience of women and girls, it is designed to include men and boys in activities for social change. 

As the publication date nears, Smith — now back in the U.S. — looks back on a long journey, from the moment in a rural clinic in Liberia when a small child lost her life, to the structural inequalities of our world, and imagines women using the action guide to begin to address these problems.

“A community health worker might pick up this book and use the chapter on family planning to talk with women about how they want to space their children. Or a community-based organization might use one of the activities to work with men on ensuring that little girls get the same nutrition as their brothers,” says Smith.

“It has been a privilege to work with and learn from so many inspiring women and girls to create this resource,” says Smith, awarded the alumni association’s Humanitarian Award in 2012. “And I’m grateful to the UW School of Medicine for giving me the grounding to help them.”

For more information about Hesperian Health Guides, please visit

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