Alumni in Action

Odunayo Talabi, MD, MMSc '22
Clinical Research Program Manager Massachusetts General Hospital
MMSc-GHD Class of 2022

by Christina Lively

I met Odunayo Talabi over zoom on September 8, a time when Boston's neighborhoods are reinvigorated with students arriving for their fall semester. Odunayo is a physician from Nigeria who graduated from the MMSc GHD program in 2022. His MMSc-GHD classmates agreed that his perspective and wisdom made him the unofficial president of his cohort. Prior to joining the MMSc-GHD program, Odunayo had worked as a physician in Nigeria. He also had started a for-profit healthcare organization, PrettyHealth with a Corporate Social Responsibility (CSR) arm through which he advocated for cervical cancer eradication and Human papillomavirus (HPV) vaccination. Odunayo continued his work on cervical cancer prevention through his MMSc-GHD thesis. For this thesis, he carried out a mixed-methods convergent study, collecting quantitative data and qualitative data in parallel. He conducted focus groups with caregivers and school administrators, vaccination sponsors and policy-makers to gain many perspectives on HPV vaccine delivery. In June 2023 he published a paper on his thesis work in BMJ: “Examining barriers and facilitators of HPV vaccination in Nigeria, in the context of an innovative delivery model: a mixed-methods study” https://bmjpublichealth.bmj.com/content/1/1/e000003.info. Odunayo’s work proved to be very timely, as the government of Nigeria will launch a major HPV vaccination campaign on September 25, 2023.

 In Nigeria, you worked as a physician and also an advocate for prevention of cervical cancer. What sparked your interest in this prevention work?

 For me it was a chance meeting with someone who came to me and said they were looking for a doctor to talk about cervical cancer vaccination. I knew the vaccine was available and the advantages of it. I thought “Why can’t we just get this vaccine to girls? Why is it difficult to do this?” HPV is very common and many girls should have access to the vaccination. This disease should be the next one we can eradicate like small pox or polio. 

HPV vaccine can prevent close to 90% of cervical cancers. The challenge is introducing the vaccine to people. We were working to create awareness. You say to people, “The vaccine can prevent cancer.” They ask “Is the vaccine going to affect fertility?” “Is it safe?” You have to let them know that the vaccine is safe.

 I was so happy to be a part of that process when the vaccine came out in around 2010.

 There were many people trying to get the word out. 

At PrettyHealth, we did two things: 1) We created awareness about the vaccine. 2) We worked to understand how we can bring this vaccine to as many people as possible. 

At that time people needed to pay for the vaccine. We wanted to see if we could see how to deliver the vaccine at a lesser cost. Every dollar saved on cost allows another girl to be vaccinated. 

PrettyHealth was a for-profit healthcare organization. We had a CSR  arm of the organization that was not profit-focused where we raised awareness. We recognized that you don't want to commercialize HPV vaccination. If this vaccine exists, every girl should get it. We approached different organizations trying to deliver  the vaccine and said we were developing a model to administer the vaccine and we were trying to bring more people to be immunized. 

We had many interesting partnerships with different organizations. People got fascinated by the idea: HPV vaccine exists. Our role was to figure out how to give out the vaccines.  

How did these partnerships form?

Our team at PrettyHealth was very motivated. We were raising awareness in social media, and regular media. Through these efforts we got connected with people who were equally passionate.  

Rotary Club international district 9110 started a program some time ago in Nigeria where they were going to vaccinate 10,000 girls. 

We [the team at PrettyHealth] approached them and said that at that cost we thought we could vaccinate 11,000 girls. We did this by reducing the cost of vaccination delivery so we could reach more people. By then we had established ourselves as people who are knowledgeable as about HPV vaccinations. People started approaching us. When Nigeria was about to roll out the HPV vaccine we were approached to give our perspective on the Rotary/Lagos/Ogun states of Nigeria’s HPV school program. We were able to say, “These are the things we think can be done if we want people to take the vaccine.” 

The team at PrettyHealth administered the vaccine: thousands of  doses. We did this by going to schools, creating awareness, speaking to parents, speaking to girls. They were able to ask questions and then we could dispel their fears. We created a group of advocates for the vaccine: once parents consented for their girls, they would help get the word out to others. We were working on creating awareness, generating demand  and delivering the vaccine. We also kept data on all of this. We did not see any major side effects among those who received the vaccine.   

How did this work relate to your MMSc-GHD thesis?

The work above came before my thesis. At that time we were trying to generate demand. My thesis was anticipatory in the sense that I felt that the time would come that governments across Sub Saharan Africa would want to roll out the vaccine. If they are rolling out, they would want to find out who did not want to take the vaccine. If people don’t take the vaccine when it is introduced, it would affect many things in the value chain. They may need to store the vaccine longer, which means spending more on electricity and the possibility that more vaccine doses would be wasted. 

My thesis was to examine the question “If you roll out this vaccine to people, will they take it?” It's one thing to bring out the vaccine and another to convince people that it is good.  

My thesis was a case-control study of vaccinations being given. We were not funding the vaccines ourselves. At that point, some people had to pay for the vaccine, and some were given  for free through the generosity of sponsors. Some people who were offered it for free did not take it, and others who had to pay for it did take it, so cost was not the only determinant. That was what generated my interest in the thesis.  

For my thesis I looked at 4 groups of people who had been offered the vaccine and classified based on their responses. Two groups were those who were offered the vaccine at a cost and who did or did not take it. Two other groups were those who were offered the vaccine for free and who did or did not take it.  We asked why some accepted and some did not accept the vaccine. We thought that understanding this would help the government in their vaccination efforts.  

Thanks to my mentors and the department of Global Health and Social Medicine, I was able to do this research work. 

How has your perspective changed after completing the MMSc-GHD program?

Most of my professional work has revolved around being in the field, on convincing people to take vaccines to prevent cancer. Coming to the MMSc-GHD program changed my outlook. In the MMSc-GHD program there were things that were revealed. The question is “Do people have the agency? If they are struggling to eat, they may not be interested in your vaccination message. Even if people know [the vaccination] is good for them, There are other factors they need to prioritize.  

The MMSc in Global Health Delivery program’s perspective is unique in that the outlook is that if there are 10 people that need an intervention, then 10 people should get it. Instead of saying “We have only enough for 4 people so we will only cover 40% of the population” the perspective here is to say “Let's try to treat everyone-how do we treat more people? If they need access they must get access.”  

At PrettyHealth, we were trying to reduce the cost of vaccination, so I was so excited when I found out about the ground breaking works being led by Dr. Ruanne Barnabas and her team at MGH on single-dose vaccination effectiveness. With the approval of single dose HPV vaccination for girls 9-14 years by WHO, it means that the cost of the vaccine for 2 million girls can now cover 4 million girls. I am so happy to be at the center of where that is happening right now. Many girls are going to be positively impacted by this work. That gave me a broader view of how to improve vaccination efforts.

 The MMSc-GHD program taught us about using evidence-based research to solve problems. Tying together how theory affects field work and how one person is important.  The program faculty also taught about having cultural humility. You cannot blame people for not taking an action where you don’t know their story. You need to ask, “What made them make the choices they made?” You need to understand the social determinants of health to see what decisions people make not just on health, but in other parts of their lives.  

The MMSc-GHD program gave me the skills to do the research. This made my tool kit more complete.  

Currently WHO’s goal is that 90% of girls are vaccinated before 15 and 90% of those with cancers are treated. It was so exciting to hear that Nigeria is rolling this out this September. Nigeria is uniquely positioned to do this because about 20% of the population of Africa is in Nigeria. Other governments are starting to consider HPV vaccination efforts. What they are doing now is to introduce the vaccine into the national program in selected states in Nigeria as a starting point. This is so exciting for those of us who have been in this field for almost two decades.  

By the end of September, the government of Nigeria will roll out the vaccine. When we published the paper on our thesis about the vaccine efforts, we were so excited to learn about this new vaccination effort.  

I was so happy our thesis could be useful in some way. We were invited to join the efforts. At Pretty Health we ran the program as a private program and went to schools. We were able to ensure that we reached the girls in places where they were. Now Nigeria is hoping to vaccinate 8 million girls for a start.  

We are not sure of their exact plans, but we know the National Primary Health Care development agency (NPHCDA) alongside global partners such as GAVI (The Global Vaccine Alliance) and other national stakeholders are involved. In our own way, we’ll offer advice on the successful administration of the vaccine drawing from our experience on the field. We want it to be successful.

 Every girl should get this vaccine.  

The MMSc-GHD program gives you confidence. If you want to advocate with policy makers, you need to know what they are saying. The MMSc-GHD program helps in preparing people not only in the theoretical part but also in being able to link theory to practice and to get people’s buy-in. If you don’t know how to approach people, you are not likely to get them to work with you. Paul Farmer, Joia Mukherjee and other champions of global health modelled this when they fought for access to HIV drugs in resource-poor areas. In Nigeria, and other parts of the world we saw the change in access to ART drugs and that was life changing for a lot of individuals.

I developed my skills in research, advocacy and my ability to  go to the field and implement programs. The research skills are critical. For me the MMSc-GHD program was fantastic. 

We just welcomed our MMSc-GHD Class of 2025. Do you have any advice for these new students?
Of course! Congratulations are in order. I am happy to welcome them into this family. I know they come with a lot of experience and are already making impact in one way or the other.  But whatever experience they are coming with, I promise them they will be enriched by the program and its faculty. The MMSc-GHD program will teach them cultural humility; will teach them to decolonize global health delivery and let them know the value of small meaningful steps of care.  So to them I say: have an open mind, you will not just become a better researcher and global health practitioner, you are going to become a better human being, which in my opinion, is exactly what the world needs.

This interview has been edited. 

 

Learn more about other MMSc-GHD students and alumni. 
Return to the MMSc-GHD home page. 

Theogene Ngirinshuti, BA, MS, MMSc
Global Health Program Manager, Build Health International
MMSc-GHD Class of 2022

By Christina Lively

On July 7, 2022, one of our alumni from Rwanda, Evrard Nahimana, MD, MMSc ‘17, stopped by the HMS Department of Global Health and Social Medicine office at 641 Huntington Avenue as he was visiting Boston. We always enjoy seeing alumni when they are in town. Shortly after he left, a recent grad also from Rwanda, Theogene Ngirinshuti, stopped by.

“Have you met Evrard Nahimana?” I asked.

“Not in person - just at an online event,” Theogene said.

“He just left - let’s see if we can catch up with him.”

We exited 641 Huntington Ave and sprinted down the sidewalk. Luckily, we were able to catch up with Evrard so Theogene and Evrard could meet in person. 

In November, I again caught up with Theogene Ngirinshuti from the Class of 2022 via Zoom. The conversation I had with him has been edited and condensed for clarity.

Tell us more about what you have been up to since you graduated in May 2022.

Since July 11, 2022, I have been working as the Global Health Program Manager for Build Health International (BHI), a US-based NGO. In this role, I work on different projects for the NGO, especially around medical oxygen. Oxygen is an essential medicine. Access to medical oxygen is taken for granted in Western countries. However, there is a huge gap in access to medical oxygen in lower-income countries. In Africa, many hospitals do not have access. Build Health International has been working with the Global Fund, Partners in Health, and other stakeholders to improve access to oxygen therapy in LMICs. 

Recently, with a BHI team, I was in Madagascar to assess the need for medical oxygen and to provide technical assistance for the procurement of oxygen PSA plants to produce enough oxygen for their patients. I am also working on training biomedical engineers to ensure that the investment in these PSA plants is sustainable. In BHI, we want to upskill local biomedical engineers, train hospital managers, and provide needed support to ensure sustainability. With the support of partners, hospitals in Africa sometimes buy expensive medical equipment, but because there is no good infrastructure or enough trained workers to maintain this equipment, they do not serve their purpose. We have seen cases where a hospital buys medical equipment, and after 1-2 months, they stop working. If no one has the training to fix the equipment, they go into the “graveyard of expensive medical equipment.” This is a huge loss. We are trying to ensure that the oxygen equipment is taken care of so people can access enough uninterrupted medical oxygen. 

At the beginning of the COVID-19 pandemic, many African hospitals did not have medical oxygen. Hospitals were buying oxygen in cylinders. They could have those at the bedside of the patient. Another option is to build a plant by the hospital and produce enough oxygen locally. We are focusing on directly pumping this oxygen to the hospital so patients can have it in good amounts every time they need it. This is a way to ensure that access to medical oxygen is sustainable. We can produce enough medical oxygen locally and at a low cost in ways that are compatible with the local infrastructure. 

We all breathe oxygen all the time, but patients need oxygen with high purity, so we are trying to produce oxygen that is 94% pure. I am learning a lot about medical oxygen and all the steps to ensure it is available and more about training others. I’m gaining confidence in what it is and how it works.

Tell us more about your work as Global Health Manager at Build Health International.

The NGO is global and focuses on low-income countries. We work in partnership with the Global Fund, Bill and Melinda Gates Foundation, different ministries of health, and other partners, including Partners in Health. In my role, I recently traveled to Madagascar to understand their need for medical oxygen. I spoke with the Minister of Health and its partners to understand their needs and the infrastructure they have – especially their electrical infrastructure - to ensure they can maintain these oxygen-producing plants. These plants consume a lot of electricity, so we go on-site to understand the whole system and to advise on the type of plant we could put in that environment.

We work to understand the needs of each and every hospital. We count the number of beds and classify them by function - for instance, beds in operating rooms consume a lot of oxygen. We submit that data to engineers. Some hospitals need small plants, others medium plants, and others require bigger plants. We are careful about the plant size because if electricity is not available, using a generator to supply electricity could be expensive, and we do not want to burden the hospital. We want to help hospitals get uninterrupted access to oxygen in affordable and suitable ways for their environment.  

My role is cross-cutting, and I work in coordination, planning, site visits, development, and delivery of training materials, mostly for French-speaking countries and more.  

What concepts from the MMSc-GHD program do you think to influence your work?

What I learned in the MMSc-GHD program definitely influences my work. The thing I’m using daily is what I learned in the course on Ethnography - how to enter a new and unfamiliar society. I am also using skills I learned in Qualitative Methods as I go and speak to people to gather information. Actually, I used everything I learned in the program. We collect quantitative data and need to have exact numbers for our planning. So, I feel like I am using all the research methodologies I frequently learned in various ways. I will say that the material I learned in the Ethnographic methods course has been particularly helpful in my work and everyday life. 

I also use concepts Joia Mukherjee taught us [in the course she teaches: Global Health and Social Medicine]. I think a lot about health systems strengthening, and I remember the discussions about that topic with Joia. Some challenges we meet when talking to people in the Ministry of Health are challenges we discussed in Joia’s class, like issues around finding skilled workers and issues around finance, which is a very serious problem. When we go into countries, I know we need to be aware of the history and political economy when we work there. All of the things that we studied in the program count. The program gave me confidence that prepared me for what I am doing now.

Your MMSc-GHD thesis was “Pandemics, Biopolitics, and Governance: A Qualitative Study of COVID-19 Containment Among Citizens and Refugees in Rwanda.” Was there anything in your thesis research that surprised you?

Yes, when I looked at what was going on for the refugees. No one was specifically and enthusiastically speaking about refugee life during the pandemic. I feared these refugees would be completely forgotten in so many ways given that they live in conditions that are very conducive to the spread of the virus. However, when I was doing my research in Rwanda, I found that refugees had the same access to COVID-19 diagnostics and treatment as the local citizens - there was no distinction. That was surprising. The refugees were not forgotten. In Rwanda, citizens and refugees were treated equally. They had access to the local health system. There were ways to include them in the economy and education system.  One key point was that they had [government-issued] IDs, which was key in accessing treatment. The fact that there was that level of equity was surprising.

Something that I expected was how refugees were badly affected by COVID-19.  These are people who have already had traumatic experiences. The COVID-19 pandemic was another trauma for them. There were so many issues around mental health. 

Why do you think the refugees were well treated in Rwanda?

Rwanda is trying to design an equitable health system. [In Rwanda], we have universal access to health care. This is central to the Rwandan government. Nearly everyone in Rwanda is insured because they focus on the population’s access to health care.

The Rwandan leadership and people, in general, have had the experience of being a refugee, so they understand what it is like to be a refugee. I think they treat refugees well because they understand what it means to be a refugee. If the people making the policy have had the experience of living in refugee camps, if they do not forget their own experience, then they cannot let people suffer the same fate that they suffered. And I think the Rwandan culture is welcoming, too, so that might also have an influence. 

You mentioned that you were a refugee once. Did visiting refugees bring up memories for you?

Yes, I was a refugee when I was about 7 years old. I can remember things about the experience of being a refugee: Living in small tents, living in an overcrowded environment. When I went to do my research in refugee camps, there were things I would remember. I would picture myself being those kids. I was invited for a meal with one family, and we ate maize and beans; this is the food I regularly ate as a refugee. As I passed through the camp, I would see how life was organized. So, these refugees lived the kind of life I once lived. 

Is there a story from one person that you would want to share?
I do remember the people I interviewed. There is one lady whose family was to be resettled in Australia at the time of the pandemic break out. Still, when the family went to take the COVID test, they found that one person from the family had COVID-19. This meant they could not move to Australia. During that delay, the Australian borders closed. They had sold everything they had. When I talked to them, they were in a very difficult economic and mental situation. They were waiting for an eternity. They were hungry. They did not have enough to eat. It was hard for me to ask questions. They were hungry and had no food, and I was asking them questions. I wish I could have assisted them financially. That was heartbreaking - to ask people to talk about their problems when I cannot do anything about them.

There was another family that I visited. They were three children, a mother, and a father, living in a house with just one room. Only the father worked as a day laborer. During COVID, people went under lockdowns, and businesses closed; there was not much work. He had lost his job, the only source of income. This father told me that they reduced the meals they take. They would just take one meal a day, or the mother and the father would not eat so that the kids have enough to eat. That was really hard for me. 

Who were your mentors in the GHD program, and have you been in touch with them?

Eugene T. Richardson was my primary mentor. I keep in touch with him and talk once in a while. He accompanied me in my quest to understand biopower/biopolitics and encouraged and advised me on potential academic research programs for a PhD. My other mentor is Mosoka Fallah, who is currently very involved in vaccine equity at the Africa CDC.  He was in Rwanda recently, and we got together and talked about the project he is doing with the African CDC. He is involved in the COVID response team. His work involves traveling the continent and helping people access COVID vaccines and other diagnostics. When I went to Liberia, he was willing to introduce me to other people. I have high esteem for what he does. My Rwandan mentor is Jean Baptist Mazarati. I have known him since I was in high school. He gifted our school, his alma mater, some science books which became known as “MAZARATI.” Every kid at our school wanted to be a “Mazarati”! It’s always a pleasure meeting and talking to him about his work as a senior scientist consultant at the Foundation for Innovative New Diagnostics (FIND), a researcher on malaria resistance distribution in Rwanda, a leader in Global Health, and an adjunct professor at UGHE.

Are you in contact with other classmates?
Our class was connected as friends. I keep in close contact with my classmates, and connecting with them is always a pleasure. They have become a family. I keep close contact with Pacifique, a fellow Rwandan. I was able to meet his family, mother, brother, and his wife. When I went to Liberia, he connected me with others there. In Liberia, I met Nanejae’s son. This is a great moment, a highlight of my visit to Liberia. The MMSc-GHD program is not just an academic program. It opens the door to the world: friends and classmates. It was wonderful. 

What are your future plans?
Many things are unfolding. However, my vision and desire are to promote equity and fight all kinds of injustices. The cause of refugees is very appealing to me. They need advocacy in so many ways, including access to quality healthcare. I can impact this as I have lived as a refugee myself, worked for refugees, and did some research in refugee camps.  We have so many refugees on the continent facing challenges I faced: people who need advocacy and whose problems require complex analysis and understanding. I feel like this is a potential area to direct my attention to in the future.  

What advice would you give to people considering the MMSc-GHD program?

Don’t think - just apply. It is a life-changing experience. It is really a program that is beyond just an academic program. It is a family where you find support in so many ways. It is a program that equips you with many different skills to do many different things.  The program can open up different horizons for what you can do to promote equity and fight injustice. Do not hesitate to apply. 

MMSc-GHD Alumni in Action Seminar

Access to Healthcare for Migrants and Refugees -- a 10th-anniversary panel discussion with MMSc-GHD alum Theoge Ngirinshuti, Ana Cristina Sedas, and Manami Uechi. Joia Mukherjee moderated.

Migrants and refugees are some of the most vulnerable people in the world, and face particular challenges in seeking health care. In this panel three MMSc-GHD alumni will discuss their work on migrant and refugee health, and participate in a moderated discussion with MMSc-GHD Program Director Joia Mukherjee, MD, MPH. Manami Uechi, MD, MMSc ‘20 is a physician who led a recent effort to establish social and healthcare services for asylum-seeking clients at the MGH Asylum Clinic at the Massachusetts General Hospital (MGH) Center for Global Health. Theogene Ngirinshuti, MD, MMSc ’22 conducted his MMSc-GHD thesis research on the barriers and facilitators of COVID-19 containment among citizens and refugees in Rwanda. Ana Cristina Sedas, MD, MMSc ’21, is Technical Advisor on Health and Migration in the Health and Migration Programme at the World Health Organization.  

Aneel Brar, MA, MMSc, PhD
Co-Founder & Executive Director, Mata Jai Kaur Maternal & Child Health Centre
MMSc-GHD Class of 2016

Aneel Brar graduated from the MMSc-GHD in 2016. Since then, he’s been busy finishing his PhD at Oxford in 2020 and starting his family early in 2022. His current work includes scaling up the perinatal depression program Khushee Mamta to meet the needs of the program’s catchment area. He hopes to eventually cover a full district in Rajasthan, India. To do this, Aneel and his team are conducting qualitative, community-based participatory research projects to capture counselor and patient experiences as the program gets scaled up.

In his email, Aneel says there is very little evidence based on counselor and patient experiences informing the scale-up of evidence-based interventions, and he hopes to fill this knowledge gap. As part of his PhD research, Aneel conducted an ethnographic study to understand the lived experience of perinatal depression. His thesis will serve as an additional critical evaluation of the assumptions and evidence underpinning global mental health interventions.

In preparation for our 10th-anniversary talk “Mental Health as Global Health” on November 18, we reached out to Aneel to understand his work in the mental health field since his time in the GHD program.

How has the program influenced your work since graduation?

The MMSc-GHD program has been life-changing in almost every aspect of my life. It is hard to overstate that! From a career perspective, it pushed me toward the PhD in Medical Anthropology (it is hard to not be inspired by the likes of Paul Farmer, Byron and Mary Jo Good, and Arthur Kleinman in this regard). It also nudged me towards incorporating global mental health programming into our work (very much inspired by Vikram Patel and Bepi Raviola). I’m sure that the skills and perspectives I gained in the program helped me land the Grand Challenges Canada grant for the Khushee Mamta program. On a more personal level, I met my wife in Boston, and sometimes when I tuck my new son in at night, I think about the circuitous path through Harvard that brought him into my life! I also have a wonderful network of colleagues whom I continue to work with.

How have you seen mental health evolve in global health?

There has been an enormous change in accepting mental health as a priority in global health. This largely concerns the accumulation of evidence on the burden of disease and innovations in community-based and task-shared interventions. A good example of this on the level of global discourse is the inclusion of mental health in the Sustainable Development Goals (there was no explicit mention of mental health in the Millennium Development Goals). This acceptance has been echoed locally in many countries, for example, with the passage of the mental health act in India, which guarantees access to care for sufferers, and the decriminalization of suicide in many countries (the criminalization of suicide being a vestige of colonial rule in many places). Having said that, despite more attention and focus on mental health as an area of focus for global mental health funding, mental health is still a neglected issue. I think it’s hard to not think it’s because there’s not a lot of incentive to focus on the suffering of the poorest and most vulnerable.

How has mental health care impacted your life (personally or professionally)?

I consider myself lucky not to be a sufferer of mental illness. I am, like most people, surrounded by it — many members of my extended family suffer from depression and have experienced suicidal ideation. I became drawn to global mental health when I saw how profoundly women in rural Rajasthan suffer beyond what could be addressed by our conventional maternal health programs. Working in GMH has profoundly opened my eyes to the structural and social causes of illness and the variety of suffering they engender, from mental and physical illness to gender-based violence.

Who were your mentors in the GHD program, and how have those mentorship relationships evolved?

I had a wonderful team of mentors: Mary Jo DelVecchio Good, Lisa Hirschhorn (now at Northwestern), Bethany Hedt-Gauthier, and Arlene Katz. Paul Farmer, Byron Good, and Join Mukherjee were tremendous sources of support for me during my thesis research. Post-graduation, I published with Bethany and Lisa, and I maintained wonderful relationships with my mentors. I think MMSc-GHD mentorship is special because of the shared overall mission — it’s not just about graduating, changing the world. That ethos continues past the end point of the degree. Beyond my official mentors, I’ve found so much support and guidance among many GHD faculty, classmates, and alumni. I feel privileged to be a part of this group.

What sort of research have you been working on this year?

Currently, I am working on two Canadian tri-council-funded research projects related to the Khushee Mamta program. One is a qualitative project called “decolonizing global mental health,” in which we are using community-based participatory interview and qualitative analysis methods (where the participants help us analyze their responses) to get the unfiltered perspectives of counselors as they go through the process of “scaling-up” (i.e., going from counselors to trainers and managers of other counselors) a part of the task-shared model that does not have enough evidence supporting it.

Second, we use a method called “photovoice,” whereby we provide cameras to the women (depressed and non-depressed mothers) to document their daily lives. We then have the participant researchers (i.e., the mothers) help us interpret the photos to better understand the conditions leading to perinatal depression.

What are your career goals over the next five years?

I would like to expand the Khushee Mamta program across Rajasthan and India (and elsewhere!) with the help of colleagues and partner organizations. I want to build up the non-profit I run (the Mata Jai Kaur Maternal and Child Health Centre). I would like to establish an academic career to have an institutional home base for this work. And I’d like to continue doing ethnographic writing and storytelling that uncovers the hidden lives of the people  (often women) who are on the frontlines of global health programming as both providers and recipients of care. I want to be a writer for academic and public audiences to support global health equity.

Is there anything about the program you’d like people to know?

What more can I say? I love the MMSc-GHD program and am grateful for everything I’ve gained. 

MMSc-GHD Alumni in Action Seminar

Mental Health as Global Health -- a 10th-anniversary panel discussion with MMSc-GHD alum Ginger Ramirez, J. Reginald Fils-Aime, and Aneel Brar. Vikram Patel will moderate. Joia Mukherjee will host.

At this panel, three MMSc-GHD alumni, Ginger Ramirez, Aneel Brar, and J. Reginald Fils-Aime, will discuss their thesis projects, their path after the MMSc-GHD program in the context of their work in mental health. They will discuss themes like integrating the voices of the people in program development and implementing integrated programs. The conversation will be moderated by Vikram Patel, who has led research and interventions in mental health across the world and who co-leads the Mental Health for All lab and the GlobalMentalHealth@Harvard initiative.

Remy Pacifique Ntirenganya, BSc, MMSc
Pharmacy Lead, Partners In Health
Liberia 
MMSc-GHD Class of 2022

By Bailey Merlin

Remy Pacifique Ntirenganya logs into our Zoom call right on time. He looks more at ease than I’ve ever seen him, due in no small part to the fact that I always seem to talk to students while they are frantically finishing assignments. We exchange pleasantries as old friends do, and it’s easy. Pacifique is no ordinary friend, though. My good friend is a pharmacist with over a decade of experience in global health delivery and is currently the head of the pharmacy department for Partners In Health (PIH) in Liberia. Despite being the head of a department, Pacifique’s work doesn’t happen in the big city. He works at the PIH site in Maryland County, a district that is perhaps a stone’s throw from the Ivory Coast.

He’s been busy, he tells me, which is no surprise given that his work combines clinical pharmacy, supply chain, and pharmaceutical management. With clinical pharmacy, he supports PIH health centers and clinics. He works with the clinical teams to ensure the appropriate use of pharmaceuticals and treatment plans and supports pharmacy teams. On the other side, he works with global health procurement and supply chain management. He works with teams to identify the medical needs of professionals and patients before procuring those things from the international markets and vendors. He ensures supplies are brought to Liberia and then works to decide where items ultimately go. The cycle goes around and around, but there are signs that the system is strengthening.

Before moving to Liberia, Pacifique worked with PIH in Rwanda as a pharmaceutical supply chain analyst and pharmacy program manager. He’s a Global Health Corps alum, a member of the Network of European and African Researchers on Antimicrobial Resistance, and currently serves on the Liberia National Antimicrobial Resistance Sentinel Surveillance Steering Committee. Pacifique’s research interests focus on health technology assessment. A fresh graduate from the 2022 cohort, and things have changed a lot since May.

Not only did Pacifique get married in August, but he also started applying his skills from the program as soon as he returned to Liberia.

BAM: You’ve been busy! Graduated in May, married in August, and now back to work. How’s it been going? How has the GHD program been helping you?

RPN: When it comes to leadership and management, I apply those skills. Now I think about global health procurement, supply chain management, and value chains. I think about how to collaborate with others. How do I make impact? How do I measure that impact?

In his day job, Pacifique brings the elements of evidence-based research—skills all GHD students learn in the program—and shares them with his team to strengthen their work with data-driven decision-making. His team is working to apply biosocial analysis to his work, too. For instance, for patients receiving care for TB, he wants to also understand whether or not those patients have food, their living conditions, stable economic status, and transportation. From there, the team works to ensure patients receive social support. Because, as many of us are beginning to learn, health doesn’t start in the hospital.

Pacifique attributes these immediate applications to Joia’s class on Global Health Delivery and Paul Farmer’s influence on the program. He insists that learning about biosocial analysis instead of just focusing on a biomedical approach allows for a fuller scope of both a patient and patient population, which translates to better health outcomes. Learning quantitative methods with Mary Kay Swith Fawzi and qualitative methods with Hannah Gilbert and Norma Ware allowed him to generate knowledge for research to the point that he now teaches his colleagues. In five or six months, he hopes to see the fruits of these labors.

BAM: Looking back two or so years ago now, I have to know, what made you want to come to this program and get an MMSc-GHD in the first place?

RPN: For me, I have worked in global health delivery as a pharmacist for a long time, but I didn’t think it was enough. I really wanted advanced skills in research but also a deep understanding of those fundamentals of global health delivery. For me, I was used to the biomedical approach. Like, okay, the patient is sick, and then we use these medicines to treat the condition…I thought it was enough, but it isn’t enough. I liked this program because it was unique in helping students understand global health issues in a holistic manner. These problems are complex, and you can’t address them alone or with one approach. We need to collaborate and understand the historical background and the political economy of a country…I needed this program to see all of that. I was satisfied with my experience because now, all those gaps I had in my education have been filled.

BAM: While you were on this educational journey, what would you say surprised you the most about the program?

RPN: The first thing that surprised me was how much I didn’t know. Even after 9 years, there were still so many issues and theories I didn’t know. I thought I needed to just be a Pharmacist to help people, but I soon learned that global health is collaborative. It’s interdisciplinary. You need people without clinical backgrounds to address global health challenges.

BAM: Now that you are on the other end of that interdisciplinary experience, what advice would you give a current or prospective student?

RPN: First of all, be ready to run and understand those new concepts. Second, be ready to apply them in your daily practice. Find a mentor who will help you in the process, and then be open to seeking help if you need it. Feel free to reach out to anyone because you have resourceful people to help at every level: leadership, program management, teaching faculty, and your classmates. Be ready to share but also prepared to learn from others. If you are open and willing to learn, then you will be successful.

BAM: That’s lovely. Before we sign off, I’d like to know: Are you working on any projects that you want to highlight?

RPN: I am working on a number of projects, but one, in particular, is the continuation of my thesis project, “Surgical Site Infections and Antibiotic Resistance After Bellwether Procedures in Rural Liberia: A Mixed-Method Study.” We are working to strengthen that program in rural Liberia because, according to the WHO, antimicrobial resistance is one of the biggest global health risks. It impacts health care delivery in low-income countries because we don’t have to infrastructure to address these health issues. We are lucky here in rural Liberia because we have the diagnostic capacity to conduct tests to see what pathogens are causing particular infections. As a pharmacist, it is not in my professional motivation to promote and optimize effective and safe views of pharmaceuticals. And now that I am on both sides of global health procurement and supply chain management, I feel like I am involved in the whole cycle from product selection, quantification, management, and then use. This project is focused on ensuring the appropriate use of pharmaceuticals and antibiotics, which should be used appropriately but also should be used to prevent the spread of resistant pathogens. I’m working to publish my research paper, but we are already publishing some work. I am mentoring other Liberian pharmacists, doctors, midwives, technicians, and nurses in this program. It’s interdisciplinary, and it’s wonderful.

If you want to learn more about Pacifique's work, you’re invited to attend this special MMSc-GHD 10th-anniversary panel on October 7, 2022, at 8:00 AM EST. Along with other GHD alum Comfort Ogar and Sheriff Bangura, he will speak on the panel, “Procurement, Management and Safety: The Role of the Pharmacist in Global Health.” Watch the recording on YouTube.

The MMSc-GHD program is proud of its students and its mentors. The relationship between them helps develop projects and papers that have a lasting impact on the communities where the research is conducted. If you are interested in becoming a part of the MMSc-GHD community, we welcome you to learn more about the admissions process.

MMSc-GHD Alumni in Action Seminar

Procurement, Management and Safety: The Role of the Pharmacist in Global Health -- a 10th-anniversary panel discussion with MMSc-GHD alum Sheriff Bangura, Comfort Ogar, and Pacifique Ntirenganya. MMSc-GHD Program Director Joia Mukherjee will moderate.

Interview by Bailey Merlin

As the Master of Medical Sciences in Global Health Delivery (MMSc-GHD) program officially launches its tenth-anniversary celebration series, we are delighted to sit down with students and their thesis mentors to discuss their relationships during and since their time in the program. In this installment, we chat with David Angelson, PhD, MMSc ’18, and his mentor Anne Becker, MD, PhD, ScM, to discuss mentorship, David’s project, and future ambitions.

David Angelson, class of 2018, is a New Zealand-based epidemiologist. Prior to starting the MMSc-GHD program, he worked in health systems and climate change-related projects primarily in the Pacific, including projects for the United Nations Development Programme, SPREP, and the World Health Organization. Anne Becker is on the HMS faculty in the Dept of Global Health and Social Medicine and Dept of Psychiatry. After completing her MD-PhD in anthropology and residency training in psychiatry, her research focus has been on the cultural and social mediation of mental illness, with a particular focus on eating pathology. Her ethnographic work has been focused on the iTaukei community of Fiji. Her recent work has also included a mixed-methods evaluation of school-based mental health promotion.   

Unlike other mentorship pairings, David and Anne didn’t meet until David started the MMSc-GHD program. However, he sought her out specifically because of her experience in the Pacific. Having done his research at the University of Otago, David came to Harvard knowing Anne’s name: “[I] was already aware of her work. I’m not alone—one of her papers I relied on has been cited nearly a thousand times. After our meeting in 2016, Dr. Becker graciously agreed to serve as a thesis committee member. I ended up based in Fiji for my fieldwork with the WHO Division of Pacific Technical Support, concentrating on Kiribati and Tuvalu.”

 Of course, mentorship doesn’t go one way. As with all our mentorship pairings, Anne was interested in David’s background working in the Pacific Islands region because it “brought important field-based expertise and perspectives on the emerging impacts of climate change on two of the most vulnerable communities in the region and, specifically, how those might drive migration pressure.” That same background and focus allowed the pair to develop David’s thesis ideas and field research.

The mentoring experience is a formal relationship, which means some expectations have to do with thesis committee meetings, the thesis itself, and feedback. However, each relationship is different, and each mentor has a different approach to their mentee. For David, that meant suggestions, readings, and expository questions.

While David was in the field, Anne actively participated in the project. He said, “I remember her suggestions for my thesis as particularly clutch - besides being a luminary in the field, she’s an excellent editor, and her advice on approach and sequence were hugely helpful. One of the highlights was her feedback on the penultimate version of my thesis. She suggested re-ordering and bolstering a few sections in a way that wouldn’t have occurred to me but greatly improved the framing and flow. It was a privilege to have such an accomplished expert taking the time to weigh in on my thesis and research, and I know that the finished product was significantly improved because of her involvement.”

Additionally, David benefited from working with Dr. Rose Namoori-Sinclair, an accomplished economist and I-Kiribati community leader based in New Zealand. Her academic work has looked at the economic benefits of Pacific migration to New Zealand and the impacts of New Zealand immigration policy on I-Kiribati migrant health. She has also worked extensively on I-Kiribati-related initiatives for the NZ Ministry of Pacific Peoples. In 2022, she was recognized as a Member of the New Zealand Order of Merit (MNZM) for broadly serving the I-Kiribati community and New Zealand. She is a uniquely qualified, vital part of the mentorship team, whose post-GHD participation has helped ensure that I-Kiribati cultural considerations and Gilbertese-language concepts and terminology are central to this community participatory research.

It was a pleasure to learn more about the GHD program from David himself: “As I was graduating from the GHD program, Dr. Becker had an idea that was sparked by something that my I-Kiribati and Tuvaluan colleagues had remarked upon, relating to a health requirement for residence visas in New Zealand. Dr. Becker’s insight was something that had flown underneath my radar. It ended up being one of the highlights of the GHD program for me because it underscored how a successful mentor/mentee relationship entails symbioses. Without Dr. Becker’s insight, I wouldn’t have formulated certain questions about how NZ immigration policy might pose a risk to the mental health and well-being of Pacific migrants, and I think that my contribution was uncovering this initial snippet of information about a niche subject in a rarely-studied part of the world through my fieldwork. (I have no illusions that it is a symmetrical symbiosis, but it has been very gratifying to feel like my GHD work could have utility for research at DGHSM and beyond.) So, we collaborated in developing a study to examine these questions. The main sticking point was the major disruption to our plans to collect data in Kiribati when its borders were closed in 2020 (while I was already in the air heading for Tarawa!). Given the extended border closure, we pivoted again, and I was awarded funding to conduct research with I-Kiribati migrant communities in NZ via the Jeffrey Richardson Fellowship. I’m very excited about the significance of this work for environmentally-displaced people. I am very much looking forward to co-presenting at the forthcoming seminar and continuing to collaborate with Dr. Becker in the future.”

The MMSc-GHD program is proud of its students and its mentors. The relationship between them helps develop projects and papers that have a lasting impact on the communities where the research is conducted. If you are interested in becoming a part of the MMSc-GHD community, we welcome you to learn more about the admissions process.

MMSc-GHD Alumni in Action Seminar

Wednesday, June 29, 2022, at 12pm ET

On the Shoreline Between Realms of Stability: The Habitability Question and Kiribati -- a discussion with MMSc-GHD alum David Angelson, PhD, MMSc '18, and his mentor Anne Becker, MD, PhD, ScM. 

In 2020, the Human Rights Committee of the Convention on Civil & Political Rights held that “sea level rise is likely to render Kiribati uninhabitable” sometime between 2026 and 2031 (absent intervening efforts to mitigate and/or adapt), and that this degree of uninhabitability would render I-Kiribati people non-refoulable because the conditions in Kiribati would be “incompatible with the right to life with dignity”. But the parameters of ‘uninhabitability’ are not defined, and related standards (e.g. how are the impacts of mitigation/adaptation quantified or assessed) are not laid out. This research employs focus-group discussions with members of the I-Kiribati diaspora, as part of a sequential mixed methods approach that integrates epidemiologic, clinical, legal, and anthropological perspectives to address the habitability question.

Decolonizing End-of-Life Care: A Trans-Cultural Approach to Ensure Global Access to Palliative Care – a discussion with MMSc-GHD alum Christian Ntizimira, MD, MMSc ‘19, and his mentor Eric L. Krakauer, MD, PhD

Watch Alumni in Action seminar on YouTube

Interview by Bailey Merlin

The Master of Medical Science in Global Health Delivery program prides itself on carefully pairing students with mentors who oversee their research from start to finish. The relationship is on par with that of a PhD advisor, as many of our students are not naturally inclined towards research and need more assistance. Because of that, students and mentors spend a good deal of time working together to establish and accomplish manageable research goals in the short two years students must write their thesis project.

This month, in preparation for their Alumni in Action talk, I reached out to Christian Ntizimira, a medical doctor from Rwanda and the Executive Director of the African Center for Research on End-of-Life Care (ACREOL), and his mentor Eric Krakauer, Associate Professor of Global Health & Social Medicine at HMS and Associate Physician at Massachusetts General Hospital, to discuss their working relationship during Christian’s time in the MMSc-GHD program and beyond.

BM: How did you and your mentor/mentee meet?

CN: During the Harvard Palliative Care Education and Practice Course (PCEP) in November 2011, the director of the program at that time, Dr. Susan Block, introduced to me to Eric as a person who had a long experience in palliative care in low-middle-income countries (LMICs) and who would be able to support our work in Rwanda. She thought that as Rwanda has made a big step by launching its stand-alone national policy in palliative care and strategic plan in the same year (2011), his experience from Vietnam would guide our work at Kibagabaga Hospital. I remember I met Eric at the GHSM office. He welcomed me in French, which I was impressed by because it set a comfort zone between us. Since that meeting, we started to work together, and he slowly became my mentor without even asking. I was only five days of basic training in palliative care, but he was so enthusiastic about supporting my work in Kigali. He built my professional career slowly with my capacity, strength, and mistakes with patience, humor, and generosity.

EK: Dr. Ntizimira and I first met in 2011 at that HMS palliative care CME course and then again in 2012 when I first went to Rwanda at the invitation of Partners In Health to begin work on integrating palliative care in Rwanda’s health care system. At that time, Dr. Ntizimira was director (at a very young age) of one of the country’s largest and most important district hospitals. He had established the first hospital-based palliative care services in the country.

BM: What were your first impressions of one another?

EK: I was extremely impressed to meet such a young doctor doing so well in such a high and challenging position. I was also impressed by his focus not on disease but on his patients and their families. I think he significantly improved patient outcomes (such as reduced maternal mortality) and staff satisfaction.

CN: I had an excellent impression with Eric because he made such an effort to speak in French. His humility to discuss difficult topics on palliative care and publications with simple language (I wasn’t a researcher that time) make it accessible in my understanding.  In my previous experiences, most of my colleagues from Western countries tried to minimize our work or focus on challenges rather than accomplishments. Eric Krakauer was different; he wanted to know my story (how I came to palliative care), our work, and how he could support us.

BM: How did you work together to design Christian’s project? What approaches did you take?

EK: Dr. Ntizimira is a thinker and always full of ideas. He recognized that palliative care is a great idea. Care for the seriously ill and dying has been provided since time immemorial, just not in the Western technological way. He recognized that palliative care should respond to the needs of the population it serves, and the population of Rwanda is not the same as that of Boston or London. So, he began thinking with me and others about what might constitute optimum palliative care for Rwandans.

CN: The project focused on bringing different perspectives in palliative care based on the experiences I’ve learned in Rwanda and Western countries. I understood the critical point of contextualizing patient care because of the social construction of realities. The main challenge was exploring our backgrounds, the historical context of death and dying in Rwanda, and the impact genocide against the Tutsis has had on the perception of death. I discussed with Eric, and we agreed to design the research project to demonstrate that palliative care needs to be adapted depending on the context.

BM: What was it like working together while Christian was in the field?

CN: Eric and I have been developing a way to communicate since 2011 because talking and communication are two different concepts, in my opinion. Even if emails were the primary mode of communication, I usually called via WhatsApp (yes, Eric has a WhatsApp account) to discuss the challenges I faced in the field.

BM: What were some sticking points in the project? Or, how did you handle conflict?

EK: The effort to decolonize palliative care has ruffled some Western feathers. But there is usually is a way to agree on the basic focus on preventing and relieving human suffering. This is a work in progress.

CN: As Eric mentioned, decolonizing palliative care was the critical point in the project. We agreed to focus on the project’s starting point because the decolonization of palliative care will need more evidence to support the idea of a paradigm shift in our practice.

BM: What would you say makes a successful mentor/mentee relationship?

CN: I think communication, humility, and honesty are the key ingredients that make a successful mentor/mentee relationship. Since I met Eric, he has always been honest about different topics we discussed, even if I don’t always agree. Sometimes, we agree to disagree, which is good because it gives a chance to rethink each other’s position. Humility because Eric taught me the most important life lesson: “One day, student. One day, teacher,” which reminds me that life is a mutual experience, not a one-way process.

BM: How has your mentor/mentee relationship continued past the GHD program?

CN: I think it will continue above professional career because the relationship is more about people than work. We are lucky that palliative care is more than withdrawing or withholding medication; it’s about dignity, a sense of humanity, and especially: Ubuntu. Ubuntu means “I’m what I am because of you.” So, someday, the career will end, but not the relationship.

EK: I suspect that Dr. Ntizimira and I will continue collaborating until I drop.

The MMSc-GHD program is proud of its students and its mentors. The relationship between them helps develop projects and papers that have a lasting impact on the communities where the research is conducted. If you are interested in becoming a part of the MMSc-GHD community, we welcome you to learn more about the admissions process.

A Biosocial Lens on Comprehensive Services for COVID-19 in Immokalee, FL: Applying Lessons Learned from MDR-TB Care in Cange, Haiti -- a discussion with MMSc-GHD alum Jude Beauchamp, MD, MMSc ’17, and his mentor Carole Mitnick, ScD.

Watch Alumni in Action seminar on YouTube

Interview by Bailey Merlin

The Master of Medical Science in Global Health Delivery program prides itself on carefully pairing students with mentors who oversee their research from start to finish. The relationship is meant to be involved, on par with that of a PhD advisor, as many of our students are not naturally inclined towards research and need more assistance. Because of that, students and mentors spend a good deal of time working together to establish and accomplish manageable research goals in the short two years students must write their thesis project.

This month, in preparation for their Alumni in Action talk, I sat down with Jude Beauchamp, a medical doctor from Haiti and a graduate of the class of 2017, and his mentor Carole Mitnick, a professor in the Department of Global Health and Social Medicine, to discuss the work they did together during Jude’s project and since.

In fairness, Carole and Jude have worked together for a long time. They met in Cange, Haiti, in 2012, and both focused on strengthening activities for the multi-drug resistant tuberculosis (MDR-TB) focal point for Zanmi Lasante (a sister program of Partners In Health). Then, Jude was a new doctor, and Carole had been working for PIH since 1996. They had a lot to learn from one another.

The divergence in Carole and Jude’s approaches comes as no surprise. Carole had worked with PIH for a long time, though her interest in TB and MDR-TB came after a fellowship for the Institute for Health and Social Justice, which never let her go. Jude, on the other hand, is a doctor for the people made by the people. Having grown up in Haiti, he was committed to his communities. After graduation, he went to Liberia to provide health strengthening around MDR-TB, then HIV, then COVID. Recently, he has moved to the United States to pursue an opportunity to be a Senior Project Lead that provides technical advising for implementation. At first, that job concerned COVID-19 testing and contact tracing but has since moved to vaccination rates. In any case, he still sees his work concerned with health system strengthening. 

BM: A unique aspect of our program is that sometimes our students meet with their mentor in the field instead of the classroom. How did you meet?

JB: I remember when Carole came to Cange, and I think we had a very interesting and frank conversation about how she might help. I was trying to give my perspective about what we were doing [in Cange] and how she could be helpful. After that, we kept in direct contact because I was invited to be in the TB group. When I was admitted to the master’s program [in 2015], automatically Carole came to my mind as a potential mentor. From there, I think I learned a lot from her, and I can say that her mentorship helped me grow professionally, especially around TB research.

CM:  Jude is very polite. I gave him a hard time; that’s probably my guess. I don’t remember exactly, but there was very limited TB care in Haiti, and Zanmi Lasante (ZL) provided the bulk of it. And I think a part of the reason I was there was to increase the scope and ambitions of that program. There was a lot of hesitation about going into more communities and managing and supporting patients after they were discharged from in-patient care. That hesitation about figuring out ‘how-to’ really restricted how much care ZL was able to provide at that time. So I think I was really pushing [Jude’s team] to use the same kind of imagination that ZL and PIH together have used for many other challenges to be able to broaden access to care without compromising quality. We knew that there were a lot more patients out there that were being found. That’s what I was pushing, so I don’t know if Jude remembers that differently.

JB: I remember that’s how our first interaction went. It was honest, but I think we were pushing things a bit differently. Because now I honestly have a better sense of your work. But for myself, as a clinician in Cange, all my activity was around [care in Cange], so you were pushing it around in a more general way, more of a public health outreach kind of way, and myself at that time had been focusing all my work on Cange…I think that sometimes that’s where the divergence in our care was.

CM: That’s a really good point. I think you were very focused on supplying the best care possible to the patients in front of you. The patients who were hospitalized, the patients who might be coming in for ambulatory care, and I was focused on getting more people to have that care. And those were hard things to reconcile, given the structure of the program and the resources immediately available.

BM: Jude, what was the thing that made you come into the program?

JB: I was patient-focused, and I think I was very interested in doing more with more people, trying to put in place quality improvement. I remember that I did a small presentation on how to improve TB patient weight, as simple as that may sound. So, we had to improve screening with HIV, trying to be more community-minded, thinking about how we could go the extra mile beyond just Cange. It gave me a lot of interest in better access to care. Knowing people who went into the MMSc-GHD program, such as Fernet Léandre and Dimitri Suffrin, and looking into the program curriculum, I thought it would be a good program for me and that I would be a good fit. I reached out to Joia, Paul, Fernet, and others to ask their opinion. I know it’s a challenging program, so I was gauging my likelihood of getting in, and everyone told me I would be a good fit. I think that this is one of the best decisions that I have ever made in my career.

BM: What does it mean to be a mentee/mentor on the cusp of a new project? How do you work together?

CM: I think it’s dynamic. I think it’s quite special in our program because the degree of investment for both parties is special, or more like a doctoral relationship, even though it’s over a shorter period. I think what I, as a mentor, was expecting was for Jude to have a question or questions that were critical to global health and equity in some way. And that my expectation of myself was that I was to help him shape that question into something answerable in the confines of this program.

JB: I think the mentor/mentee part of this program is as important as the academic courses. I’m saying that because my impression was that when you’re doing a master’s program, taking courses and passing them is more important than anything else. But [the mentoring part] of the program is crucial, and I think students, faculty, and staff really need to think about these relationships. Everyone needs to be really involved. Everyone should think about students and faculty fit together because it is so crucial to this program. Myself, I think that Carole provided me more than I was expecting. Not more than I needed, definitely, I needed all of it, but I think I’m comparing myself to other students at that time. I’m sure that my mentor provided me the most time in my cohort, and I think this was very important in helping me navigate and succeed at this master’s, particularly the research part.

CM: After establishing the research question, which is itself a project, as Jude can attest, my expectations were dynamic throughout. For example, when Jude was taking his classes, I expected that he would be doing some extra reading around his particular topics to inform the instrument he was going to use to refine his question. We were able to focus on an area that hadn’t been addressed in other studies. It was a very specific question about what happens to patients with MDR-TB who have been cared for in-patient for several months when you discharge and send them back to conditions that may not be very conducive to their continued improvement from their illness and whether that’s because they have a lot of household responsibilities, whether it’s because they had to bring in money, whether it’s because they don’t have enough food. After all, they were victims of violence because it was hours and hours to get a follow-up appointment. All of those things are very real issues, so it required a lot of work on Jude’s part to kind of narrow the scope of the question and develop instruments that could be approved through an IRB process. Then when he was doing his field research, my expectations changed again. It was important for Jude and his growth to deeply engage in and experience the lives of his patients after they were discharged and then to reflect on that. Some of which I think were really painful for Jude to see and then to further discuss, but that was part of the expectation of being true to the social medicine value of representing the lived experience of patients we are ostensibly trying to help.

BM: When you were no longer in Boston, what were you reaching out about to Carole? What is the mentor/mentee relationship like when the student is in the field?

JB: I think it’s trying to make sure that I’m staying on track. Not only for the academic purpose, as Carole mentioned, but also as a kind of building of myself in what I’m doing. For instance, this ethnographic part of the research and ensuring that I’m going into the community and trying to live patients’ experiences. I think that was the expectation of constantly checking to see if anything was cropping up because nothing ever goes as planned to make sure that we have a backup plan that we agree on as quickly as possible. What are we doing in the next steps? Again, Carole was very gracious with her time. Having weekly set time helped me stay focused and display what I was doing.

BM: What were some sticking points in the project? What went wrong?

JB: The timeframe was a concern because it was my first research project, so I was trying to involve as many patients as possible, but we were very constrained by the time frame; also, the program has a heavily qualitative focus, and Carole has a quantitative background. I learned a lot from that. How can I come up with something quantitatively stronger than what we were trying to do? But again, Carole found ways to educate me on quantitative parts. It was difficult to do, and I’m grateful for her help.

CM: I would just add that Jude was very nimble and willing to try different things. We had things that didn’t work out along the way, but you were very persistent, which made it easier to take chances if something went wrong. I was confident that [change] wasn’t going to crush him. And if you were hiding that over mini-failures and I didn’t notice it, I’m sorry. But I think that we were both trying to produce a research product that would be meaningful in the field of global health that would represent the patients that Jude was trying to serve, which was also a learning experience. As Jude said, as time grew shorter and the number of patients whose experience could be followed in the course of his research project shrunk, we did need to come up with some creative ways to have a little bit of quantitative part in there, and that was really as a learning experience for Jude as it was for me. I think we put some new ideas out into the literature about what one might think about how to measure progress or detect a lack of progress for people who had been discharged. And I can’t say enough about having a real qualitative mentor on the project and [Arlene Katz’s] support of interpreting Jude’s interviews and ethnographies, which were so rich, helped us overcome some of our challenges in which I felt out of my depths.

BM: What makes a successful mentor/mentee relationship?

JB: That’s a good question, and the funny part is that I’ve experienced it but saying it doesn’t come easy. I think that having people who have some common interest, not necessarily the same interest in the same field, but maybe having the same scope of interest. Does that make sense? Because I do think that my working in TB and Carol working TB made things less difficult for us to work together. Speaking as a student, knowing what you want, and not being shy to ask questions, letting your mentor know your weaknesses and how they may be helpful on the journey is also important for success.

CM: Those are great points. They seem obvious that overlapping interests would help, but it really does help a lot having mentored students whose interests are outside my area of expertise; I just personally feel like I can bring so much more when I’m not playing catchup and learning background information. But probably even more important than what Jude said, which is honesty on the part of the mentor and mentee. Honesty about expectations, honesty about whether they’re not being met—on both sides. For a mentee to express what they need is important, and if those aren’t being met, for the mentor to hear. And I think, like in most relationships, I think that listening is really, really important. Sometimes, I would lose sight of that value in thinking that my role as the mentor is to tell Jude what he should do or be knowledgeable or that it was important for me to always have an answer. And I think that listening to Jude and what he was learning and where that was taking him was extremely valuable to me in continuing to learn how to mentor as I was going through the process. I think that listening comes with some humility. Jude was outside of his comfort zone as a clinician, and really approached his work with great humility helped me tell him that I didn’t always know all of the things he was going through. I didn’t have all the answers to the questions he was posing. I didn’t know how to do a research project that looked at the transition in care. I had never done something like that, and so approaching these projects with humility and curiosity are great attributes.

BM: How has your mentor/mentee relationship continued past the GHD program?

JB: It’s even stronger! I think Carole is my mentor, maybe life-mentor, should I say.

CM: I hope so.

JB: Carole helped me a lot. We continued working on publishing the paper from the thesis, which we eventually did last May. So, thank you. We tried several times, and even though I didn’t abandon it totally, I was focusing on other things, and Carole got me back on track with it. We tried one more time, and we published it. Even things outside of the master’s program, other careers paths that I’m seeking, Carole is always happy to listen to me and give me her perspective. It’s an evolving mentor/mentee relationship.

CM: I want to reinforce that it is such a pleasure to maintain this relationship with Jude and even have it grow. It always makes me joyful to talk to Jude and get updates to hear about the next adventure. I think of you as very brave. You went off to Liberia, you transitioned into a lot of different work in Liberia, now you’re off doing this COVID work in Florida, and I have great admiration for what you do, so it’s such a privilege to have the foundation of having first met you in Haiti and then working closely with you in the program.

I look forward to continuing to grow the relationship. I think of it more as an exchange, not just a unidirectional mentorship. I really value what I learn from you as well, Jude.

The MMSc-GHD program is proud of its students and its mentors. The relationship between them helps develop projects and papers that have a lasting impact on the communities where the research is conducted. If you are interested in becoming a part of the MMSc-GHD community, we welcome you to learn more about the admissions process.