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Interviewer:
Staff
EDITOR'S NOTE:
At their request, to
protect their current position and future opportunities, the identity
of the individual being interviewed has not been included in this
article. All other individuals who are mentioned have consented to
have their names included. It is the interviewee's hope that by
helping readers in the developing world understand the importance of
foreign funding and assistance in Sub-Saharan Africa that they can
make at least a small difference in the ongoing discussion regarding
the current cuts.
When
at immigration, keep quiet, goes the adage. I was traveling by myself
- a 16 year old at immigration in Paris. I kept quiet about the petri
dishes in my suitcase - bacteria on agar plates, sealed with that
stretchy material that you pull on and wrap around the plate to close
it. The esteemed Pasteur Institute had decided to help me, a high
school student, with my science fair project. When they did, I found
out the bacteria on my agar plates was a new species, they called it
Bacillus soil1, straight from the dirt in my classmate’s back-yard.
The phylogenetic tree showed it was not distantly related to anthrax.
Do I need to mention how fortunate I was no one asked me what I had in
my suitcase in the airport?
Where did you grow up and how did your education and community trigger
your interest
in science?
I am
really blessed that I can call two different places home. One is where
I was born, in the Balkan, Eastern Europe and Caucasus region, and the
other where I spent much of my childhood and adolescence, in
Sub-Saharan Africa. Our backyard in Africa was home to a multitude of
creatures, insects, spiders, and chameleons. This piqued my interest
in the natural world. I also was an avid reader.
My story
is not particularly uncommon, one of my parents was a refugee and had
a break to study in another country. That parent then returned to
their homeland, when it was possible to do so, with a spouse and child
in tow, and a love of learning. As it was a new country at that time,
the spirit of optimism was everywhere. I believe it is still there; we
have a great deal left to do.
Was there a special teacher or incident that sparked your interest in
taking your petri dishes to Pasteur?
I would not pin it down to one incident per se. But I
had noticed there was this major disease claiming the lives of people
in the community and that got me interested in microbes. Those were
bleak times in my country. I distinctly remember my fourth grade
science teacher showing signs of what I would later learn was AIDS. My
French high-school teacher passed on shortly after she had become a
widow. At that same high school, I had extremely competent teachers,
including international ones. The two that come to mind are: my
biology teacher (from Canada) and my Chemistry/Physics teacher (from
the Philippines) both of whom really pushed me
to enter the science fair. I am so grateful to them and all the
teachers in my school.
When I
went to Paris, it was for a scheduled holiday. I just happened to
combine it with a trip to the Pasteur Institute, which I did not
declare at immigration. At the Pasteur Institute I was fortunate to
receive assistance from Professeur Grimont in the Bacteriology
department. It was his good will to help a science fair student from a
country that had just appeared on the map of Africa after years of
colonial rule.
What happened after the science fair?
I did not make it past the national competition,
despite my high school being known for producing consecutive Science
Fair winners, who would go on to represent the country at the
international competition. Part of the reason was I had no control for
my experiment (sometimes, we do miss the basics, in search of the
exemplary). Nevertheless, I used the entire science fair experience in
my applications to universities in the United States.
No less
than two years later, I had a full-ride to an Ivy League university -
a place I had only heard of before, but discovered was a formidable
institution while I was attending classes there.
What stands out in your college experience in the USA? Were there
professors, lecturers and others who nurtured your interests? Was
going to the USA a real culture shock?
I was stunned by the amount that students were doing,
at any given time! Back home I remember people being easy-going, not
always in a rush driven to accomplish the next thing. That was the
major culture shock - the pressure to remain focused and working at
high speed all the time. I can definitely say every single instructor
and professor from all departments, not just my own - Molecular
Biology, were extremely dedicated to us. I was very impressed by how
inspirational they all were. It was not just the Nobel Prize winning
tenured professors, but everyone on campus.
However, it was
also very grueling, as at the time we had a system known as grade
deflation. It meant we competed mostly for the coveted A grades, which
only went to those in the top 30% of any class. I remember doing a
problem set with a classmate who cried (she is an epidemiologist today
and doing well at one of the big pharma companies). Overall, it was
an incredibly empowering experience. I went home immediately after
graduation and I truly believed I could do whatever I wanted. I was
fortunate to find work right after graduation.
After you graduated, what was the next step in your education and
career?
When I graduated, the US was in the middle of the Great
Recession - one of the worst economic downturns in living memory. I
had not been admitted to graduate school. I wanted to study
epidemiology, but they required work experience as part of the
application process. When I realized I wasn't going to graduate school
I was already at the end of my undergraduate career so I did not end
up applying for the prestigious fellowships that would have been my
alternative as my university had links to many of them.
Returning home, to Africa, felt like let down, noting that I did not
know a single fellow African who returned after graduating from
university in the United State. But going back to my
country turned
out to be the best decision I could have made. Because of my interest
in public health it was the perfect time to return to Namibia. I was
driven to address the scourge of HIV and AIDS, which was pervasive in
my country at that time. My country was very
fortunate because it received one of the largest grants of US aid
dollars (when calculated on a per capita basis). These grants fell
under the PEPFAR program in Africa. The CDC had been on the ground in
Africa since 2004, having benefited from the injection of PEPFAR funds
which started the programs and associated surveillance designed to
curb the rising tide of infection and abate the deaths we had become
so accustomed to in those years.
How did you get a job as part of the program?
I often wondered if it was my degree from an Ivy League university
that opened the door for me, but I found a job by merely asking about
how the country collected data on HIV prevalence. The Ministry of
Health housed a special directorate that was born out of PEPFAR
funding to the country. Now, in 2009, they needed staff to work on a
census that would map the health facilities in the entire country, and
take an inventory of health providers, services, the works! I remember
getting the call on a Saturday to attend the training; I visited
Friday afternoon. Certainly the team from CDC knew of my university
and its reputation. They were not the ones to hire me though, the
government was, but I assume they had a say. I only got the offer
after completion of 3 weeks training. My role was to manage a team of
data clerks, as well as update the Demographic Health Survey Office in
the US, which would write the report. I will never know for sure
what opened the door for me but I will be forever grateful. This was
my first job in public health, my way into the field. Thanks in part
to the US government, one of the key donors to the project.
What happened next to advance your career?
Working on that first job, I met two incredible CDC staffers who
shaped the remainder of my career to date. Sadhna Patel, an
epidemiologist, worked on everything related to HIV at the time. The
epidemiological aspect of that first job entailed field workers going
to every single health facility in the country and recording the
numbers in the health information system of that facility. I remember
perusing handwritten ledgers that documented patient visits and the
associated clinical information. I was despondent when I discovered
the entire census exercise, meant to be a true census, left out the
prison health facilities. How could we leave out a group that were so
vulnerable to HIV infection? I didn't have the authority to change the
scope of the project, because our Ministry of Prisons would have to
sign-off for our access to their facilities before we could
investigate prison sick-bays and clinics. Sadhna let me know this
would not be the end of the information gathering, as the CDC was
planning further projects to look at HIV not only amongst prisoners
but also others, such as sex workers and gay, bisexual and other men
who have sex with men. Thanks to her mentorship, I eventually did my
MPH at an esteemed institution and presented my research on HIV among
a vulnerable population at the AIDS Conference in Durban in 2016. Most
importantly, this I turned my despondency at returning to Africa into
a drive to learn. She has remained my mentor in the years since she
left the country.
After your MPH what did you do next?
In those early years, I started writing
about public health and I found
support
from the CDC. One of the aspects that fascinated me was how our
national blood transfusion service dealt with HIV prevention. Unlike
the situation in the global North [Europe & North America], there were
no restrictions put on GBMSM for donating blood in our country. The
HIV epidemic became pervasive very quickly. There was no known
trigger, such as a blood transfusion event or an initial outbreak
among members of the GBMSM community, that started it all. By the
time I had returned to my country, large swathes of people had already
succumbed to AIDS in the years before the US government dollars
brought antiretroviral therapies to us. There was also no
epidemiological data to say the blood transfusion led to the outbreak
in my country. As a result there was no need to adopt such measures.
Lastly, no one spoke about the GBMSM population, so it was
understandable that the blood transfusion service did not mention them
on their intake form. There was no such community that had been
documented in my country despite the fact that we knew it existed.
I had
been a blood donor since I was 16 and I started writing about my
experiences remembering that I was barred from donating while I
studied in the US. Around the time I met Sadhna, one of the other CDC
staffers introduced me to John Pitman. John worked on supporting the
blood bank and the issue of transfusion related acquisition of HIV. My
country had very little visibility for GBMSM people but I shared the
blog I had been writing with him. It was John who encouraged me to
continue putting down my experiences as a donor on paper. A few years
later, in 2018, I
personally mentored two young activists. I
provided them an idea for an HIV prevention intervention for young gay
and
bisexual men that
centered on blood donation. Their submission made it to the shortlist
of the contest organised by the US based non-profit MPACT Global
Action for Gay Men's Health and Rights. All of this happened thanks to
the encouragement I received from John Pitman.
You've accomplished a lot in your life so far, what do you want the
reader to understand about it?
I would say it is important to me to share how the
presence of the U.S. in my country benefited my career as a person
from a Sub-Saharan African country. I am concerned that the US funding
cuts we are hearing about will negatively impact my country and others
like me. I want people to understand how important my CDC mentors and
others in the developed world have been to my career and how critical
funding for these projects are to the future health of Sub-Saharan
African countries, and not just the HIV epidemic in Eastern Europe and
the Caucasus region which were growing whilst epidemics in our region
were contracting. I hope that by spotlighting what I have experienced
I have been able to put a personal face on the importance of the
support from the developed nations.
By the
mid to late 2010s, there were several US government funded public
health agencies and universities in my country. With them, came
numerous epidemiologists, either hired directly by the US government,
or working for different contractors. One of my undergraduate
classmates in the US became a fellow for the CDC. Another American who
had invited me to apply for the project he was leading, an estimation
of HIV incidence in the country, could scarcely believe I had attended
the same Ivy League university as his colleague, who I had met before
he did. “No, I don’t think so,” was what he said, when I mentioned
that she and I took a dance class together when we were students. Only
later did he realise I was not mistaken, indeed I did attend this
prestigious institution, despite having been raised in Sub-Saharan
Africa.
The
recruitment agency that processed all the hires for the US government
funded public work in the country did not hire me for this project in
the end. One could not work on US funded public health jobs without
going through that recruitment agency. At the time, I found it
annoying, but now I appreciate it. Without an independent recruiter
individuals like myself, who were well networked due to our academic
backgrounds, would have had the upper hand in applying for these
positions. Contrary to the most recent accusations we hear are being
leveled against U.S. agencies working in my part of the world, there
was actually a great deal of rigor involved both in terms of hiring
and spending.
Why didn't you end up working with the CDC?
The closest I came to working with the CDC was in late
2020, when I applied for a role I knew was a stretch for me at the
time. At that point I had not done a field epidemiology training
program, but the position was about responding to health incidents, as
well as performing ongoing surveillance. I did the interview via Zoom,
as was the practice at that time, which was convenient because I
wasn't in the US to interview in person. Of the three member panel, I
knew one person - Dr Leigh Ann Miller. Leigh Ann had given me work
just a few months prior, when I worked with the Ministry of Health on
the response to COVID-19.
In fact,
Leigh Ann was among the few people who took time to guide me in what
was clearly my first job, post my MPH, working on a pandemic. Thanks
to her, I worked on the situation reports of the capital region of our
country, while also offering support in statistical programming. And
here she was on my panel. As it turned out, I was not what we call in
my country “the successful candidate”. Yet perhaps it was for the
best, because little did I know that a mere three years later, the US
public health community would be eviscerated by budget cuts.
What are you doing today and what do you hope to do in the years to
come?
While I cannot
elaborate much on what I do today, suffice it to say I am doing a
training program in public health. I hope to work as an epidemiologist
in one of my two countries in the years to come. ■ |
