Category: Mentors

Mentor Spotlight: Elizabeth Bukusi

On December 20, 2014

Elizabeth Bukusi, MBChB, MMed, MPH, PhD, PGD is Co-Director of the Research Care and Treatment Program at the Kenya Medical Research Institute, and is co-PI of the Family AIDS Care and Education Services program.

What motivated you to become a researcher?
I went to work on the border of Kenya and Uganda as a young doctor fresh from internship. This was a malaria prone area with a lot of STIs too. You were sure when on call to be paged for an emergency ruptured ectopic gestation or a child with severe anemia after malaria infection. Both conditions needed blood. In the two years I worked there I was concerned about the number of blood units we discarded. In those days, the HIV test kits were not as rapid as today. You first took the blood and then you tested it. If positive, you discarded it. I watched us discard from one or occasionally two units of blood to almost five units for every ten. When you have a desperate person needing blood and you cannot transfuse them the blood donated, it sets you thinking. This is what made me interested in finding out how to make a difference to HIV and also to STIs. The ectopic pregnancies were by and large due to previous STI. After many nights responding to obstructed labor and ruptured ectopic gestation, Obgyn became a natural next step for me. I wanted to make a difference in STIs in general, particularly HIV, and specifically I wanted to influence women’s health.

Tell us about the Family AIDS Care and Education Services Program:
Craig Cohen, now of UCSF, and I started working together 20 years ago now. As we worked on HIV prevention we were struck by those who we screened out of our research studies (who were HIV positive) as initially there was not much we could do for them. The PEPFAR program gave us what we needed to be able to provide care for those who were being screened off the first HIV discordant couple study we conducted in Kisumu. We had previously worked in Nairobi but we made a strategic move to relocate our work to the then Nyanza region of Kenya which was the heart of the Kenyan epidemic then. After our initial two small clinics, one in Nairobi and another in Kisumu, we expanded HIV care to the South Nyanza region, which had the highest HIV prevalence in Nyanza where infrastructure was not as well developed and people desperately needed access to critical care. The program grew in leaps and bounds and we are currently the second largest HIV care program in Kenya (www.Faces-kenya.org). It has been a great opportunity to make an impact on the lives of many people; not only on the patients, many of whom know they would not be alive today if care had not reached them, but also on the many health care workers we have had the opportunity to work with over the years. We have had a great team who are passionate and committed to what they do, who work in what are sometimes very challenging circumstances and go way beyond the call of duty to give care.

Have you had any great experiences with being mentored or mentoring?
I have been mentored by really great people, and the selfless non-competitive nature of my mentors has done a great deal to get me to where I am today. I want to particularly pay tribute to Joan Kriess who saw, not what I was, but what I could be, and to King Holmes, who patiently and carefully taught me how to not only work towards being a good researcher, but how to always try to bring out the best in everybody. Craig Cohen and I have peer-mentored each other and it has been a great partnership as we complement each other well. Craig, much like King, has been the person with great ideas, while I have been the more earth-bound practical and pragmatic person who works through the kinks to make it work, and it has been a very good experience. Jared Baeten is another of those who have impacted my life. We were in the same class for the Master and PhD programs at the University of Washington, and Jared helped me understand that it is not who but what that sometimes matters. Asking the right questions. Giving it your best shot.

Mentoring has been one of the highlights of research for me. I am limited in what I can do as a person. I only have so much I can understand and I have only 24 hours in a day. I have had the opportunity to work with brilliant young researchers who continue to teach me so many things. I only need to nudge them in the direction of their dreams, provide a platform for support and watch them soar. I learned from King to always want your mentees to be even better than you have been and to help them do more than what you have done, because you have paved the way and made it easier for them. I hope everyone I have come across and crossed paths with leaves different and takes away something that will impact their lives positively.

What are some of the most effective measures for preventing the spread of HIV?
HIV has taught me many things. The first being that it will never be a one size fits all. It will be effective ways not way. I think unless people know their status it is very difficult for them to make decisions that can impact their lives positively. But with the stigma that still exists, it makes it hard for people to get tested and if they do, to disclose their status. How do we make it safe enough for people to stop being afraid of getting tested? Particularly in Kenya, how do we help young women reduce their risk of getting infected? As a gynecologist, it cannot escape my deep concern that the face of HIV remains a young African woman for SSA. Elimination of pediatric HIV remains a challenge because so long as we have women of reproductive age getting infected we continue to struggle for an HIV-free generation in Africa.

What is a challenging ethical dilemma you’ve encountered?
There have been many challenging ethical opportunities, but perhaps one that stands out for me is from my early days in research when an HIV positive woman was not willing to disclose her status to her husband. There was no treatment for HIV. There was no prep. Microbicides were still a novel discussion and Nonoxynol 9 was yet to be tested. What was my responsibility? She was concerned that she would likely be homeless, or that she would be told she was promiscuous. She was determined to use condoms to protect her spouse, but she would not tell him. She did not think she could get him to come and get tested. The sad reality is that this is a scenario still repeated today. Now we have other mechanisms and improved options for HIV prevention, but some dilemmas still remain in the light of the social and economic situations that many women finds themselves in.

What gives you hope in the face of a terrible disease like HIV/AIDS?
I think my hope is a lesson from the current Ebola outbreak. We live in a global village. What affects one part of the world affects all of us. We cannot afford to ignore any issue that is of global health concern in the connected world we live in. We have the momentum from the biomedical research side to really make a difference, but we need to push for the political and economic will to follow through. We know some of the things that definitely work; treatment as prevention, prep etc., we just need to act. We should not let perfect be the enemy of good. We know enough to turn the tide of the epidemic and we must do it. History will judge us all harshly if we do not make a difference. Just like for the Ebola epidemic: we cannot wait and watch, we must act now.

This article was originally published in the NPGH Fogarty Fellows December newsletter

Networking: The Importance of Candy

By FoG@rtY

On November 12, 2014

In Mentors, Peru

Joseph Zunt, MD MPH is a professor of neurology, global health, and epidemiology at the University of Washington. Originally from Minnesota, he is one of four co-PIs for the NPGH Fogarty Fellows. His research interests include infectious diseases of the central nervous system and education and training.

Joe Zunt first went to Peru on a Fogarty-funded infectious disease fellowship, spending seven months there researching HTLV-1 infections of the central nervous system in a move that would shape his career and life for years to come. Zunt went to Peru with the advice and support of Dr. King Holmes, first Chair of the Department of Global Health at the University of Washington and currently head of the Center for AIDS Research, after a Dr. Joan Kreiss, Director of the UW International AIDS Research and Training Program, advised him that the lack of CT scan machines in Kenya, where Zunt had been planning to go, would make it difficult to study brain infections in patients with AIDS. On his first trip to South America, Zunt forged friendships and professional connections with other researchers with whom he is still collaborating after 19 years.
Although Zunt trained as a neurologist and still spends part of every week in the clinic, it is clear that training and mentoring have become the major focus of his career, and Peru remains the center of many of his projects. The four main grants he co-directs all involve sending researchers back and forth to Peru for training with the ultimate goal of improving the quality of care and research on neurological disorders in that country (and in the entire world if you ask him). Add to that his own research projects on meningoencephalitis, a family life, and regular trips for conferences and workshops and you begin to wonder how he does even a third of that. But remember that strong network of collaborators he has? Nobody plans an “HIV: Mixed Methods and Sociobehavioral Research” workshop in Bangkok by himself.
Perhaps that is why Zunt puts so much of his energy into mentoring; more than just a buzzword, interacting with more experienced researchers is perhaps the most important resource a young scientist can have and Zunt’s own work has gained much from his mentors. He still meets almost daily with Holmes, who set him on his path, although their discussions are more often about the merits of malted milk balls vs. Reese’s Peanut Butter Cups over the office candy jar. When you are not too busy stressing over IRB applications and working on your research, remember to pay attention to the people around you—you never know when a conversation might spark a publication, a friendship, or an Interdisciplinary Cerebrovascular Diseases Training Program in South America.

Author: Nikki Eller. This article was originally published in the NPGH Fogarty Fellows November Newsletter

Collaborating for Injury Prevention in Ghana

By FoG@rtY

On October 15, 2014

In Ghana, Mentors

Peter Donkor, MD MPH is a Professor of Oral and Maxillofacial Surgery at the Kwame Nkrumah University of science and Technology in Kumasi, Ghana and is also Pro Vice-Chancellor. He has earned degrees, fellowships, and diplomas from six different colleges, taught at the University of Sydney and the University of Birmingham, and served on numerous advisory boards throughout his productive career.

Ghana, an African country of 25 million inhabitants is located 80 north of the Equator and 20 west of the Prime Meridian. This uniquely places it closest to the center of the earth, with her citizens being among the friendliest in the world. Other unique features about Ghana include the hand woven kente cloth; the Volta Lake (a large man-made lake); “red-red”, a favorite local dish; open drains, and mini-buses inscribed with social, religious and political messages.

The buses which are mostly used are “home second-hand” imports from Europe, and form the backbone of the public transportation system that includes vehicles that have been written off in their countries of origin either after an accident or because they are unserviceable. These buses often also serve as ambulances for the transport of the seriously ill or injured to health facilities.

Mechanics in Ghana have developed skills for restoring “dead” vehicles regardless of their state. Thus rusty old vehicles get patched up and rendered “roadworthy”. A Mercedes Benz car with a failed engine may get refitted with a used but functional Toyota engine, while the rusty frame of a Mazda vehicle may be replaced with a newer Nissan one. In the same manner that imported used clothing keeps the not-so-well-off in Ghana decently attired, imported used vehicle tires keep vehicles moving on the very poor road network across the length and breadth of the country. Like many developing countries, injuries from road crashes contribute disproportionately to the burden of disease, and undoubtedly dilapidated vehicles contribute significantly to the problem.

Over the past twenty years one NIH/FIC funded research collaboration between the University of Washington (UW) in Seattle and the Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi has focused on injury control. Activities under this collaboration have included driver education in first aid and safe transport of the injured; training of district medical officers in emergency surgical procedures; teaching of undergraduate medical students in trauma; workshops for media practitioners, police, fire personnel, lawyers, judges, parliamentarians, surgeons, social workers, engineers etc. Several Ghanaian graduates have gained MPH degrees in injury research, and faculty exchanges have also taken place.

Domestic violence, unintentional injuries such as accidental ingestion of chemicals by children, burns, suicide, and road traffic injuries require the combined efforts of law enforcement agencies, engineers, medical personnel, law makers, policy makers, researchers, and international agencies for effective control. Efforts at controlling this menace in Ghana require a multi-pronged approach and must include a strengthening of the entire health system. In an increasingly globalized world, international collaboration is a sine qua non. The recent Ebola epidemic in West Africa, and the threat it poses to the entire global community is a reminder that unless we collaborate internationally to solve global health problems, we stand the risk of perishing together. Therefore, as we celebrate the successes of the UW/KNUST collaboration, greater efforts are needed for extending the gains to benefit more communities.

This article was originally published in the NPGH Fogarty Fellows October 2014 Newsletter

Injury Prevention: A Global Team Approach to a Major Public Health Problem in Developing Countries

By FoG@rtY

On October 13, 2014

In Ghana, Mentors

Ronald Maio, DO, MS, FACEP founded and directed the University of Michigan Injury Research Center, and was PI for the Great Lakes Node of the Pediatric Emergency Care Applies Research Network. He is currently Professor Emeritus in Emergency Medicine at the University of Michigan Medical School.

On my recent trip to Ghana this past August, much of the country’s concern, and rightfully so, was focused on the Ebola crisis raging within its neighboring countries. However, the day before I returned to the US, the pernicious problem of death and disability from traumatic injuries, a problem that is my particular research interest and that of my mentees, came to the fore. There was a tragic road accident involving three mini-vans outside of Kumasi on the Kumasi to Accra Highway. Twenty-three people died and 11 others were injured. Twenty-one of those people were dead at the scene and two died in hospital. The dead and injured consisted primarily of young adults and children.

Death and disability from traumatic injuries, particularly road accident related injuries, have become a leading cause of death and disability in the developing world, and continue to be a major cause of death and disability within industrialized countries. The overwhelming majority of its victims are those that are in the early years of their productive adult life. As an emergency physician, a large portion of my training and practice focused on the evaluation and treatment of patients with traumatic injuries. My early research also focused on this area, but I eventually realized an important fact that the above described accident illustrates: most of the people that die from traumatic injuries, particularly road accidents, die immediately from catastrophic injuries. Most notably these are severe brain, cervical spinal cord and thoracic aorta injuries.

While I knew the importance of timely and high quality medical care for the injured patient, it became clear to me that I wasn’t doing enough. I needed to include prevention activities in my practice and in my research. My thinking was strongly influenced by the concepts of primary, secondary and tertiary prevention and the Haddon Matrix for injury control. This matrix can be applied to all injury events but was initially used for road accidents. It helps organize factors leading to an accident, and by filling the cells of the matrix one can develop both general and specific strategies for intervention.

At the time my perspective was broadening there were still many silos in the US addressing injuries from road accidents: it’s an engineering problem; it’s a policy problem; it’s a regulation problem; it’s a law enforcement problem; it’s a health behavior/ health education problem; and of course, it’s a medical problem. Thanks to the CDC’s National Center for Injury Prevention and Control and my early mentors and colleagues, I came to realize that death and disability from traumatic injuries is best addressed as a public health problem that requires co-ordinated multifaceted solutions. I began to collaborate with other Departments within the University of Michigan Medical School (UMMS) as well as the UM School of Public Health, the University of Michigan Transportation Research Institute, and the School of Pharmacy.

Although my research in acute trauma care continued, I also began conducting research on using computer technology to identify alcohol problems and intervene among the complete range of injured adults and adolescents presenting to the Emergency Department. An underlying concept was our perspective that a visit to the Emergency Department for an injury was a “teachable moment” to address risky behavior that could result in future injuries. Subsequently, my colleagues have expanded our work on alcohol problems to include addressing risk factors for inter-personal violence and seatbelt use. In the US, during the last 20 years, there has been a dismantling of the aforementioned “silos” and the growth of inter-disciplinary collaboration: essentially a team approach to the public health problem of traumatic injuries from road accidents.

As we help fellow global citizens in developing countries address the problem of traumatic injury in a sustainable fashion, we need to take a similar team approach. A great example of such an approach is the work that Dr. Charles Mock, a trauma surgeon from the University of Washington (UW), and his colleagues at the UW and in Ghana have been doing in the area of traumatic injury. Their work not only addresses acute clinical care issues, but also behavioral and environmental risk factors and is inter-disciplinary in nature.

We are fortunate to have the work of Dr. Mock and his colleagues on which to build and be informed, as well as his assistance with studies on quality of trauma care and also development of a trauma registry at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. These projects were headed and recently completed by Dr. Rocky Oteng, faculty in the UMMS Department of Emergency Medicine, during his Fogarty Research Fellowship. We are also conducting a project to determine the frequency of alcohol use and risky drinking among trauma patients presenting to KATH. This work is being conducted by a current Fogarty Fellow, Andrew Gardner, an M-3 at UMMS. We are also very fortunate to have the collaboration and co- leadership on these projects from the Director of Accident and Emergency (A and E) at KATH, Dr. George Oduro, and A and E faculty member Dr. Paa Kobina Forson. We think our work will have implications not only for acute clinical care but also for policy and prevention activities. We also think it will serve as a platform on which to further develop a sustainable research enterprise to reduce death and disability from traumatic injury in Ghana as well as the rest of Sub-Sahara Africa—and beyond!

My colleagues at the University of Michigan and our Ghanaian colleagues at KATH are very excited about our work and also very excited and proud to be part of the Global Team to reduce death and disability from traumatic injuries.

This article was originally published in the NPGH Fogarty Fellows October Newsletter