09/10/16

Battling infectious disease with infectious passion.

Warrior in the white coat

Cell counting in the translational lab

Unwilling to pass up an opportunity to be clad in a white again, I was a research intern at Infectious Disease Institute – Makerere university. This internship was in light of my give-back idea to contribute to the intervention against antimicrobial resistance and HIV/AIDS in Uganda through scientific research and capacity building. I envisaged that this would have a large laboratory work component in which I would train while supporting the laboratory staff in ongoing studies. Essentially, this internship would bridge the gap between my idea and its execution by giving me more information and skills for feasibility assessment.

My work at IDI was predominantly laboratory-based as I expected: I was exposed to methods used to monitor HIV/AIDS treatment, for antimicrobial testing, and several other components of microbiology and molecular biology. If anything, I was impressed by the capacity Uganda already has to tackle these issues. In my time at IDI, I was able to learn how to monitor drug levels in patient’s blood using High Performance Liquid Chromatography (HPLC). This remains impressive as a technique to study whether the Antiretroviral drugs HIV patients take actually reach the blood. I was also able to learn and perform various key pieces to infectious disease translational research including but not limited to: Tuberculosis diagnosis, leukocyte cell counts, DNA extraction and the Polymerase Chain Reaction (PCR). As part of my microbiology training, I was also actively involved in preparation and inoculation of media. drug sensitivity tests, biochemical tests and blood culture. However, I was not able to adequately study the relationships between external (and non-Ugandan) researchers and IDI. I was not able to sufficiently learn about the challenges faced in the translation of ideas developed in other parts of the world into Ugandan context and capacity. I did observe some of the challenges but it would have been a lot more rewarding to have a full conversation. This is an opportunity that did not come very often probably because there weren’t many international researchers in the laboratories in which I worked. The staff attributed this to the time of the year of my placement, which is not as work-intensive. At least, this internship has shown me that I have to pay more attention to the details of this cooperative research system since I would have to translate ideas probably not developed within the country.

Nevertheless, I was able to attend a conference during which guests from Cornell university were unveiling a mobile prototype of DNA amplification technology. This was one of the few opportunities I had to network with individuals from an external university, and a different but related field – biomedical engineering. By observing and interacting with the testers of this technology, I learnt more about the intimate relationship between the scientific techniques I am learning and engineering in developing affordable innovations.

Setting up HPLC in the pharmacokinetics lab.

I was able to work in four different laboratories which had slightly different working environments. Generally, all the laboratories were dealing with samples containing virulent pathogens, and hence there were varying levels of risk prevention measures enforced depending on the enforcement by laboratory managers. Working with virulent pathogens was daunting but I was able to work with care under supervision by the staff, especially during training. Many a time, the tension created by the nature of work was mitigated by the socially vibrant environment. The staff were able to socialize even within tasks and still get objectives done – and this is not uncommon from my prior experiences living in Uganda. It is these social moments that constitute the best part of my internship because I was able to become part of the workforce both professionally and socially.

Despite not being able to meet him often during my internship, Dr. Andrew Kambugu, my supervisor was the most influential person I met. There was a lot to learn from the way he interacted with the staff. He was positive, considerate and respectful to everyone including juniors and interns. His style of leadership is atypical in comparison to the highly hierarchal system in many Ugandan workplaces. It is no surprise that he is internationally engaged to represent and foster the research at IDI.

IDI is a dynamic research environment that I would recommend any intern looking to do international-standard infectious disease research in Africa. It would be helpful for interns to know about the risks involved in the laboratory work IDI does and prepare appropriately e.g. get immunizations. Nevertheless, I consider this internship to be an overall success because all these pieces constitute a newfound pool of information from which to derive ideas for my future career research.

04/5/16

The Clinton Global Initiative University 2016

CGIU 2016.

This year, I was honoured to be a part of the Clinton Global Initiative University (CGIU) at UC Berkeley. With the support of the MasterCard Foundation and CGIU, I was given an opportunity to be a part of an outstanding global movement. Driven by observations of the increasing socio-economic challenges on the globe and increasing ability of

At CGI

At CGIU

the world to observe critically, the Clinton Global Initiative is one of the numerous initiatives to create capacity to tackle these problems. This year, the initiative converged thousands of delegates from many universities around the world to inspire commitment to creating change within small communities as pieces of the larger picture of global development.

Going back to 2013, my greatest misfortune was the impediments between the translation of my ideas into developmental projects and impact. In developing the HYDRA 256 concept, I was driven by the change I wanted to see in remote communities in Uganda. However, I was limited in the number of like-minds and resources to set the development of the idea into motion. Despite not being able to access these resources then, being part of the CGIU this year felt like my second major chance to contribute. Through my commitment to action with CGIU, I have been inspired to use my personal career development to contribute to the public health sector in central Uganda.

My commitment to action.

I was raised by a mother who has been a public nurse for over 20 years, and therefore was extensively exposed to the healthcare system in Jinja district. Through casual interactions with the staff and patients, I was impressed by the support system in place especially for HIV/AIDS patients under The AIDS Support Organization (TASO). However, I also observed challenges within the system. I developed hypotheses to explain the challenges I saw, but did not have an opportunity to undertake rigorous research to identify these challenges and contribute to finding solutions. The CGIU system has given me the much-sought opportunity to channel this curiosity into action. My commitment is to develop a protocol for monitoring HIV/AIDS treatment in low-income settings and promote adherence in central Uganda. This also aims in long term to also deal with multi-drug resistance that is wide-spread on the African continent due to misuse of available drugs. This would be a research based commitment as an incremental effort to the already existing medical and public health research on HIV/AIDS in Uganda. This is also inspired by my career aspirations in Immunology/Microbiology. My commitment to action also aligns with my summer internship in which I will be engaged in translational research in HIV/AIDS at the infectious Disease Institute at Makerere University. I intend to use this as an opportunity to kick-start the commitment and also have practical exposure to assess the feasibility of my project.

Why commit to research?

The research commitment aims to alleviate mortality due to HIV/AIDS arising from poor adherence and accessibility to treatment. The findings of my reports would be useful to bridge the gap between the sources of treatment and the affected patients. This will be by providing a well-researched set of guidelines for public health personnel to execute treatment programmes and evaluate their proficiency. Another issue that could subtly be addressed by this research is the multi-drug resistance that is associated with poor treatment adherence especially for opportunistic infections at the AIDS stage. There has not been extensive public information of the risks of this drug resistance. The target population is East and Central Uganda, with a focus on Kampala and Jinja districts.

What success would look like…

As with most scientific research, my project’s value is incremental and informational. I intend to write a comprehensive report on the current system of diagnosing, treating and monitoring HIV/AIDs infection. The real value of this report would be to use these observations to optimize the control of HIV/AIDS mortality right from the level of health policies down to the patients and society. In effect, this project aims to instigate the revision of policy and process surrounding treatment.

Perhaps the more unique aspect of my research would be to investigate drug resistance by pathogens, using HIV/AIDS patients as a starting point since they are constantly exposed to antibiotics and antivirals. Through my education and in my community, there wasn’t a strong emphasis on the drug resistance due to misuse. This makes such communities a ground zero for a foreseeable global medical catastrophe known as the “post-antibiotic era” which would be in large due to lack of emphasis on appropriate drug use in developing nations. My commitment should raise awareness on the matter through advocacy.

Personal lessons from CGIU.

 

With President Bill Clinton (left), me (right) and P. Wangui, a student member (centre)

With President Bill Clinton (left), me (right) and P. Wangui, a student member (centre)

In addition to focussing my plans to contribute to society, there were several more specific moments of learning at CGIU. I was honoured to personally meet President Bill Clinton, the 42nd President of the United States of America. In his addresses, I found many messages to be revolutionary in the way I think about being part of change. He reiterated the significance of interdependence and particularly, the importance of positive interdependence as opposed to negative interdependence. I vividly recall his inspirational drive for reporting failure in order to use it as a foot hold for future development. Subtly, this speaks to my personal inaction for fear of failure. A more human message from the former US president was to see people as individuals and pay attention to each and every person.

A salient theme of the CGIU was engagement of local communities in solving their own problems. In his opening address, Bill Clinton stated that “the people closest to the problem are closest to the solution, yet often furthest from power”. I find remarkable truth in this statement and the promotion of individual empowerment through CGIU serves to bridge that gap – an effort I was encouraged to believe I can be a part of.

With Chris Ategeka (right).

With Chris Ategeka (right).

I was also able to network with several students from across the globe and listen to amazing initiatives. This has broadened my network of like-minded people and given me an opportunity at peer mentorship. I was honoured to meet and receive advice from Chris Ategeka, a successful Ugandan-born social entrepreneur who was featured in Forbes 30 under 30. If there was anything to learn from Chris, it was how he sustainably developed projects for community support and empowerment. I was impressed by his model of maintaining financial sustainability and using it as an effective pitch to garner more funding. Furthermore, Chris’ idea to use mobile clinic and motorcycle ambulances to increase accessibility to health care in rural communities ignites questions surrounding the use of these methods to increase accessibility to HIV/AIDS testing and treatment.

More specifically, I attended several workshops including those about securing funding and storytelling to effect change. I find these quite relevant to communicating my ideas and getting support to get them off the ground.

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My reflections are on going.

Overall, my learning experience at UC Berkeley was highlighted by the flamboyant weather and the vibrant community of San Francisco. My reflections from this extraordinary experience are ongoing.