What's the dilly, yo

Ki kati, people (that’s Luganda, for ‘Yo’). I’ve gotten more than a few ‘What? You’re in Uganda right now?? Why???’ emails, so now that I’ve got a somewhat reliable albeit slow internet connection at work and can update this blog regularly, I thought I should at least give some background on what I’m doing here this year.

The NIH Fogarty International Center, now about 40 years old, supports global health research by providing US and international investigators with grants to the tune of over $60 million each year. One of its programs is the Fogarty International Clinical Research Scholars program, or FICRS. Since 2004, each year the FICRS program has offered 20-30 US graduate-level students in the health professions the opportunity to train at NIH-funded research centers in resource-limited settings in 20 or so countries. This year, I am, lucky enough to be one of those students. I am working at the Infectious Diseases Institute (IDI) in Kampala, Uganda, an NGO that provides clinical care and antiretroviral therapy (ART) at the clinic, trains health professionals from all over the continent, and conducts research into HIV and related infectious diseases. As far as I know, it is unique in this triple focus. (For those who don’t know, Uganda has had relative success in controlling the AIDS epidemic through coordinated clinical care, and as such places such as the IDI have had the luxury of being able to focus on research and training rather than in establishing effective health systems. If you want to read more about that, try these links:
- http://www.who.int/inf-new/aids2.htm
- http://en.wikipedia.org/wiki/HIV/AIDS_in_Uganda
- http://www.avert.org/aidsuganda.htm

So anyway, the bottom line is that I will be here for a year doing HIV/AIDS clinical research. My principle investigator (PI) Yuka Manabe, who I’ll talk about at length a bit later in this blog, has a background in tuberculosis basic science research at Johns Hopkins, where she has been a faculty member for 10 years or so. She has a special interest in something called IRIS, immune reconstitution inflammatory syndrome. What is IRIS? Say you have HIV and you live in the developing world, and you are started on ART. There is a 10-25% chance that in the first 3 months of being on therapy, you will actually get worse. Why? If you have advanced HIV, your immune system stinks. If you start on ART, you get it back. But when you reboot your immune system by starting ART, suddenly your body mounts an inflammatory response against all the different pathogens with which you were likely infected when you were severely immunosuppressed. In other words, you were actually TOO sick to show that you had TB or Cryptococcal meningitis when you were immunosuppressed, but now that you’re on ART you actually HAVE all these things and are suffering clinically. Why do IRIS research? To figure out whether preventive screening is effective, how to prophylax against it, whether IRIS interferes with other comorbid conditions…you name it and it needs to be characterized.
- http://en.wikipedia.org/wiki/Immune_reconstitution_inflammatory_syndrome

If you actually read all that, I’m very impressed. It’s complicated and probably a bit boring to read about. But there it is. And here I am.

So yeah, I arrived in Uganda five days ago and will spend the next 10 months here, based out of Kampala but spending a good chunk of time out in the boonies of Western Uganda to work on a big PEPFAR study. Check out this map if you want to see where I’ll be working, small villages called Kibaale and Kiboga are (pronounced Chee-ball-eh and Chee-bo-gah):
- http://www.ugandamission.net/aboutug/image/ugmap.jpg

To start at the very beginning, I’ll just pay brief lip-service to the events of the last month or two leading up to my arrival in Kampala.

June: End of 3rd year & Leaving NoHo/Baystate
Quite an end to the year. For those of you who don’t know, I was living out in Western Massachusetts for the past year, working at Baystate Medical Center in Springfield. It was an incredible experience—Baystate is a fantastic hospital and health system, and their self-proclaimed emphasis on medical education rather than research made it an ideal environment for medical students. I felt so comfortable and happy there by the end of the year that it was harder to leave than I had thought it would be. The same can be said for Northampton, where I was living. My apartment, the first 1-bedroom I’ve ever lived in and probably the last for a while, and the town itself were so charming. I had a great time there and miss it quite a bit already. My lovely parents came to help me with the Herculean task of packing up the apartment and moving my whole life into storage. It wasn’t fun and I was a sad, crabby girl, but my parents were unfailingly patient with me. I couldn’t have made it through that time without them! After the move, I had about a week of hanging out in Boston through July 4th, hanging out with friends and trying to prepare myself for what was coming the next week…

July: Fogarty Orientation @ the NIH & Nashville
I’ll say in advance that many of my friends from Fogarty have written extensively on our two-week session in Bethesda, so I’ll refer you to their blogs if you’re looking for more detail about the experience (look at the links section in the section on the right side of this page). From my end, I arrived in DC July 5th more than a bit trepidatious and wondering what I’d gotten myself into. While on an intellectual level I knew that this would be a once-in-a-lifetime experience that I was lucky to have, I missed my life and my friends in Massachusetts already, and I worried whether I would love the program as much as previous Fogarties had promised me I would. Of course, all of my worrying was for naught (and was pretty dumb, I’ll be the first to admit it).

The orientation was indeed an incredible way to start the year. Getting to know all the other 32 Fogarty scholars and our 32 international counterparts or “twins” (scholars from the countries where we’re going with whom we’ll be partnering on our research projects), as well as 25 post-doctoral level Fogarty fellows (read: geniuses) was awe-inspiring and fun. They are a motivated and accomplished group, not to mention some of the nicest and most adventurous people you’ll ever meet. It was a normative experience as well—all of us in this program have felt an inexplicable tug towards global health for a long time and have been trying to explain it to graduate school admissions committees or advisors or friends and relatives all along, and finally finding a room full of colleagues and mentors who not only understand this drive but have excelled in their careers in this field already felt like coming home. It’s a great network to be a part of. The program administrators, from the NIH Fogarty International Center itself, from Vanderbilt University (the group that manages the FICRS program) and from the Association of American Medical Colleges made us feel welcome and special as they guided us through a couple of weeks of research presentations (e.g. New Immunodiagnostic Techniques in TB), basic topics in global health (e.g. emerging neglected diseases), inspirational talks by world-renowned leaders in global health (e.g. Tony Fauci on how he ended up where he is now), and presentations by various NIH institute directors (the head of NIMH telling us about the global burden of mental health diseases, the research that is needed and that we could do in the next year). We learned a lot, partied a lot, and generally exhausted ourselves. It was fantastic.

While I was in DC, I also got to spend time with my family and some close friends, which was a special treat. My mom and dad live in DC (though my mom had to trek down from her vacation home in downeast Maine), and my sister Julie and aunt Sandra flew in from California for my dad’s birthday celebration and to say goodbye to me. One of my best friends in the whole world from growing up in DC, Hannah, also lives in DC, and I got to see her several times as well (more than in the last year or two, probably!). It was lovely to see them all, and sad to leave them.

We Fogarty scholars split up after the two week orientation for an additional mini-orientation at our US partner sites. Mine was at Vanderbilt in Nashville. A relaxing few days of meeting administrators, touring the campus and hospital, and taking in the music scene on the strip capped off the trip. I’d never been to Nashville before but I will definitely be back. Fun fun fun.

End of July/August: Boards & Goodbyes
I flew back to Boston after orientation(s) to wrap things up before I left. I had, in a fit of ambition, decided to take Step 2 of my USMLEs prior to taking off for the year, but finding the time or motivation to study was harder than I had anticipated. Anyway, I squeezed in study time in between fun with friends, loaded up on toiletries and flip-flops, and got ready to go. Where I had been nervous and morose about leaving before the training in DC, afterwards I was energized and excited to start my adventures. Though there were many tears and difficult goodbyes, I left Boston feeling ready to move forward and grateful for every minute I’d had with my friends and family, not only in the months leading up to my departure, but in the 3 years I had with the Tufts class of 2010 (best class ever).

My father would be proud of the amount of context I just laid out. Have to do some work now, but in my next post I’ll actually start talking about life in Uganda, I swears.