In the Field or in the Lab, One Researcher’s Journey to Making Every Intervention Count
Assistant Professor of Epidemiology
June 12, 2019, Epidemiology, Faculty, Advocacy, Epidemiology, Global Public Health, Health Disparities, Infectious Disease, Research, Social Epidemiology, Vaccines, Women's Health
As a kid, I was really interested in disease outbreaks—which I think is true for a lot of people who go into infectious disease as a profession. I remember watching Outbreak as a kid. The folks in the film were doing all kinds of public health work, of course, but they all seem to be lab scientists or physicians. You have a CDC person, but public health isn’t represented as such.
As an undergraduate, I studied biology and figured I’d be a physician. I got a lab job studying yeast genetics and really enjoyed it but was also realizing I didn’t want to spend all of my time in a lab.
Following college, I took some time off to travel. I wrote letters to schools in Nepal to volunteer as a teacher and ended up at a school in the Kathmandu Valley. In figuring out what to do with my weekends, I ended up working on two different health-related projects, and these really got me interested in public health. One was an environmental study of waste disposal and where villages sourced clean water—or not so clean water, as the case often was, sadly.
The messenger wasn’t trying to be helpful, but the message turned out to be quite helpful.
The other project was an NIH-funded project working with Nepalese women returning from India who had started to develop symptoms of AIDS. Most of these women had been sold by their families to traffickers in India, selling off one daughter to be able to afford a good marriage for the other daughter. If they contracted HIV and became visibly ill, they would be sent back to Nepal and dropped off in the capital. They couldn’t return to their villages and families. The women would try to work as prostitutes in Nepal.
The intervention was to try returning these women to their villages. To me, the intervention was misguided—these women would never be welcomed in their home communities. One of the local study coordinators listened to my objections and suggested I should have a doctorate before having such strong opinions and trying to make decisions. So that’s what made me think, “You know, maybe I should get a PhD.” The messenger wasn’t trying to be helpful, but the message turned out to be quite helpful.
Back to the Lab
Even with my field experiences in Nepal, I still felt comfortable in a lab and began studying molecular and cellular biology at UC-Berkeley. Once there, I started attending a lot of public health seminars on campus and after a year or so realized I had probably enrolled in the wrong program. I liked the lab work but was interested in more applied work.
“Perhaps you’re in the wrong field.”
Then an investment banker turned Bay Area startup mogul turned neglected tropical diseases expert joined the lab. After he had gotten to know me, one day he said, “You know, you could certainly stay here and do well. But the talks you get excited about are over in epidemiology and public health. And between experiments we don’t catch you reading Cell. We catch you reading The Lancet and The Economist. Perhaps you’re in the wrong field.”
I thought on that for a while, for a few months. Then I had a day in the lab where everything worked out incredibly well, several experiments I’d been doing came together, my advisor was excited—literally jumping up and down. And I just didn't have the excitement I should have in that moment. I went outside and laid out in the grass for a few hours thinking about things. I walked back in and quit my PhD program. I stayed around to wrap things up but meanwhile was applying to and beginning epidemiology program at Berkeley.
The epidemiology program began with an MPH, and my internship was in Nicaragua. I really connected with the people there. I loved doing study design, and the master’s program showed me how to do applied public health science using many of the lab techniques I was familiar with.
Vaccines and Global Health Work
As a PhD student, I continued working in Nicaragua and began my interest in influenza research. Nicaragua had never run a standard lab test to detect influenza virus, had never isolated a virus, and did not yet have a flu surveillance program. I began working closely with Nicaraguan partners to set up lab training and to establish collection protocols and sampling methods. With local colleagues, I had the privilege of helping to develop the initial influenza surveillance program for the country.
When I quit the doctoral program in biology, I had at first felt like I was going off the road. As I began looking back, it was all making a lot more sense.
Vaccines are part of the front-defense against infectious disease that developing and middle-income countries can invest in with good financial and health returns.
As a researcher and professor, I’m still in the lab a lot, and I’m still in Nicaragua a lot. Most of the work my research group carries out is pre-work for vaccines. We collect data needed to inform the design of new vaccines and the improvement of current vaccines.
It can be a struggle communicating just how important all of this is to prospective students. So many of them are interested in global health work but don’t see themselves doing lab work. Or they want to work in a lab and don’t see themselves working abroad.
Vaccine work can be this amazing intersection of lab work, field work, and global health engagement. Vaccines are part of the front-defense against infectious disease that developing and middle-income countries can invest in with good financial and health returns. Most vaccines are highly effective, require only a few doses, and provide long-term or life-long immunity. An intervention like that, which can be delivered according to a nation’s basic patient schedule, is a tremendous advantage to that population’s health.
Michigan has a strong history in flu research, like the Tecumseh study, and in vaccine research, like the Salk vaccine and so many other innovations in vaccine science. All of that really attracted me to Michigan. So did the school’s commitment to building labs that balance field and lab work.
I’m a field epidemiologist. Field studies take a long time to set up and start getting in data. It can be difficult to launch a career as a field epidemiologist. But once your system is established and you have papers coming out and studies in the works, you can focus on the things that engage you the most.
Every intervention, every vaccine, every survey counts.
Meanwhile, all that ground work gets you deeply engaged with public health at a grass roots level—working with community partners, building networks of trust and training local technicians, collecting samples, carrying out interventions. Here you see that every intervention, every vaccine, every survey counts. Each of those can help a family or a community get healthy or stay healthy. It may not be the stuff of movies, but it is very rewarding.