Life Lessons Learned: Research with ICAP in Swaziland

Going into the summer with ICAP, I expected to learn about global health and the tools used to conduct medical research, but that hardly describes my summer in Swaziland. These experiences made an enormous impact on me and have universal qualities that make them applicable to anyone. So I’d like to share a few of these moments.

Perhaps the most salient knowledge I gained from ICAP was an understanding of how public health translates into practicing medicine for populations. For chronic infectious viruses like HIV, an individual’s care is directly linked to the health outcomes of every person s/he is in contact with. Gathering data at the health care facilities, we would often hear stories of men and women whose inability or refusal to remain in HIV care led to immediate outcomes within their communities. While trying to track down information for one patient’s file, a nurse explained that the man in question repeatedly fell out of care: taking medication for weeks at a time, disappearing after experiencing significant improvement, etc. During these periods of attrition, his virus would adapt and multiply, forcing his nurses and doctors to repeatedly intensify his treatment. Eventually, the virus mutated to the point that there was nothing left to be done. Just as his team feared, this individual loss led to a communal tragedy as patient after patient enrolled with the same resistant virus.

This story solidified my answer to a question we were asked from Day 1 with ICAP: Why should we do international research? We could have done this in the US, where it is also an epidemic in certain populations. Despite all the political and social implications of international relations, the answer is simple. Just as time elucidated the communal effect of an individual with inconsistent treatment, it will also elucidate the global effects. Look at this year’s Ebola outbreak: the entire world has watched as the outbreak evolved from an local to an international concern, with cases now beginning to surface in Europe and the United States.

With the ability to travel to almost any point on Earth in a day, we live in a global community, creating a two-fold obligation for international partnership. There’s the self-serving responsibility enforced by the reality that an issue over there is just a quick trip from being an issue over here; but, more importantly, we have an obligation to collaborate in the face of adversity because that’s what good neighbors do. That’s why international research is so important.

Then there’s the relationship between the people and the project. A Swazi researcher told me about his role in a study where he asked people to do an HIV test in order to estimate the prevalence of HIV in Swaziland. This task is simple in theory, but he encountered many barriers. He told me the most important aspect of his job is to accommodate and empower. For example, he once went to a farmer’s home in a rural part of Swaziland. Because it was so far from a health facility, it was likely the first time that the family was tested. So he began his interaction with them by helping with their harvest, building a respectful relationship by putting their priorities ahead of his. After a while, he explained the importance of HIV testing and asked when it would be most convenient for him to come to administer their tests. The researcher emphasized to me that, for many, the stigma surrounding HIV creates a wall of fear that only compassion, understanding, and knowledge can break.

Dr. Hilda Hutcherson has been an invaluable mentor of mine since I attended the Summer Medical and Dental Education Program at Columbia during my sophomore summer. She once told me that the best learning happens at the edge of our comfort zone.  In Swaziland, I discovered that there are two ways to live at the edge of the comfort zone – with fear and with determination. I chose the latter with my eyes wide open, ready to learn. Now, when people ask me about Swaziland, I can tell them about my HIV research as well as fun outings, the beautiful landscape, and even a bit about Swazi politics. And, I’ve brought that same mentality to my senior year.

From my experience with ICAP in Swaziland, I’m more confident in my pursuit of improving global health. Through understanding the necessity of international partnerships, prioritizing people over projects, and approaching new situations with determination, I feel prepared to make a difference in the lives of others. I’ve learned that public health hinges on the idea that the health of one is the health of all.