Training the talent in trouble spots

The Harvard Initiative for Global Health (HIGH) has begun a fellowship program with the aim of identifying and helping train bright young developing-world health professionals in remote regions of the world with the greatest global health challenges.

The Global Health Scholars Program, in its first year, has identified its first two scholars: Conrad Muzoora and Francis Bajunirwe, promising junior faculty at Mbarara University of Science and Technology in Uganda. The program helps fulfill a central theme of HIGH’s recently completed initial strategic planning process: supporting and building in-country training and research capacity.

The program is supported by Mbarara University Vice Chancellor Frederick Kayanja, who told program Director David Bangsberg that if there was one thing he could do for Mbarara it would be to help them retain their best and brightest.

Bangsberg, a senior research scientist at the Harvard Initiative for Global Health and lecturer on medicine at Harvard Medical School, said rural universities like Mbarara that are not located in city centers face a double “brain drain.” There is the external brain drain, where talented Africans train in programs in other countries and never come home. But there is also an internal brain drain, Bangsberg said, where talented people who train in rural settings such as Mbarara stay in their home countries but move to the big city. Mbarara’s mission, he said, is to train health professionals who will live and work in rural areas.

“Whatever public health initiative you want is constrained by the ability to develop local leadership,” Bangsberg said. “The goal is to identify the best and the brightest, support them through a mentoring and training program, and train them to be local and international leaders.”

The program was Bangsberg’s brain child. After years of research into the treatment of HIV in poor settings in the United States, Bangsberg took his work to rural Africa, specifically Uganda. His research was among the first to show that HIV could be successfully treated despite poor health care infrastructure, overturning the conventional wisdom of the mid- to late-1990s that had delayed the distribution of antiretroviral drugs to the world’s poorest places.

If one examines which parts of the world are hardest hit by HIV and tuberculosis and compares them with the places where most of the scholarship and research into those diseases is done, they don’t match, Bangsberg said. While the highest burden of disease is concentrated in the world’s poorest nations, most of the research is coming from the industrialized nations, such as the United States and Western Europe.

“Our goal is not to slow down productivity in [Europe and the United States] but to speed up productivity in rural areas, so that leadership better reflects the impact of disease,” Bangsberg said.

A pilot program this year, the fellowship program is limited to the two scholars at Mbarara. Bangsberg said if the program is successful, he’d like to expand it first to other African locations and then outside of Africa.

Unlike many programs where scholars spend considerable time at Harvard, global health scholars come to Harvard for coursework and receive ongoing mentoring from Harvard faculty, but are based at institutions in their home countries. This is to help foster local leadership.

“The plan is to develop a training and research program primarily based at their home university, helped by coursework and mentoring here,” Bangsberg said.

The two fellows hold lectureships at Mbarara University of Science and Technology. Muzoora grew up in the region and attended Mbarara for his studies, making him an ideal candidate for the program, Bangsberg said. Muzoora, who was at Harvard in the fall, is conducting research on how HIV/TB co-infection affects HIV treatment, with the aim of improving treatment strategies and diagnoses.

Bajunirwe, a medical doctor who also has a Ph.D. from Case Western Reserve University, is coordinating the master’s of public health program at Mbarara and is conducting a “brain drain” study, examining the emigration of the university’s professional staff — seeing where they go and why they leave.

Bajunirwe said the Global Health Scholars Program will allow him to get mentoring from leading experts in HIV, epidemiology, and global health, which he hopes will help him develop as an independent researcher and become more competitive for research grants.

“I would like to build on what I have already learned as a graduate student and pass on this knowledge to the upcoming generation of Ugandan scientists,” Bajunirwe said. “Our country has been hit hard by the HIV epidemic and other preventable diseases and there is a lot of work to be done.”

The program provides benefits beyond those that the fellows receive. The fellows themselves can serve as resources for current Harvard students who seek to travel to international settings. With an existing relationship with Harvard, the global health scholars can mentor and guide those students when they come to visit and learn.

“We think the quality of that relationship would be fundamentally different, and offer fundamentally different value, than a similar relationship here,” Bangsberg said. “They [the students] find not only a mentor to a new area of science, but a new culture as well.”