By Rachel Cox
For more than two months every spring and summer, students in the Master of Science in Global Health program travel around the world and within the US to conduct research for their capstone project. They apply what they’ve learned in the classroom to active global health projects, and present their findings at the program’s end in July. Students often say their capstone experience is the highlight of the master’s program.
In 2017, the students’ research took them around California and to 16 countries. Their projects included a cost-effectiveness analysis of “safer” conception strategies for HIV-discordant couples in Zimbabwe; drug research for the treatment of lymphatic filariasis, conducted at a UCSF lab; and evaluating healthcare access for Syrian refugees in Lebanon.
Some students know their research interests when they start the program, and others find capstone opportunities that help develop their passions. Jamen (Jay) Rose Garcia and Tommaso Bulfone represent each type.
A clear vision
Jay Garcia entered the master’s program with a clear vision: to research eye disease and improve global eye care. She had already spent a year in Ghana volunteering for the NGO Unite for Sight providing screenings for patients before they underwent eye surgery, and wanted to return to work there with new skills and knowledge. Garcia’s mentor, Lady Neelam Sekhri Feachem, MHA, connected her with Aravind Eye Care System in India, known worldwide for revolutionizing eye care.
Based at Aravind Eye Hospital in Madurai, Garcia did a retrospective data analysis to compare the follow-up rates of glaucoma patients who went for treatment and monitoring at that hospital with the rates of those who went to Aravind’s Vision Centers in smaller communities. Her findings would show the effectiveness of the primary care vision centers in enabling patient follow-up, and help Aravind improve and expand their glaucoma care throughout India.
“The master’s program challenged me to stretch myself,” Garcia said about doing quantitative data analysis for the first time. Whenever she felt overwhelmed working with more than 14,000 data files or started to question the impact of her work—sitting at a computer most of the day instead of interacting with patients as she had done in Ghana—she reminded herself that thousands of people were regaining their sight through cataract surgery and other treatments as she worked. “I was thinking about what was actually happening at this moment,” she said, realizing her work would impact future eye care.
Although Garcia could have analyzed data for her capstone project anywhere, she chose to go to India to see first-hand how the Aravind Eye Care System works. She observed screenings and treatments, and was inspired by the organization’s conviction that not one person in India has to go blind. She said she was amazed by their success: “This is legitimate, this is real, this is happening… people are getting their sight back.”
Garcia would like to adapt the Aravind model for eye care in Ghana and elsewhere to produce similar outcomes. “This experience definitely moved me toward my goal,” she said, as she prepared to enter a new position at Unite for Sight after graduation.
Garcia’s time in Madurai also allowed her to experience some of the local culture, exploring the area with other researchers she befriended at Aravind’s hostel. They visited eateries (her favorite dish was paneer butter masala), attended movie screenings and festivals, and took a few overnight trips to other cities. She enjoyed wearing clothing bought from local shops, having fragrant jasmine garlands placed in her hair at Hindu temples, and drinking strong, sweet chai several times a day.
A project with 'serpent-dipity'
Tommaso Bulfone’s capstone research also was fueled by chai—5 to 10 cups a day, he said, as he met with people around Nepal to discuss a potential clinical trial for a new snakebite treatment. Being able to join the research team of his mentor, Matthew Lewin, MD, PhD, FACEP, was fortuitous for Bulfone, who said “the project brought together my interests in neglected diseases, wilderness medicine and diseases that affect the poorest of the poor.”
Nepal has the highest recorded incidence of snakebite in Asia, but antivenom treatment is generally available only in hospitals that tend to be far from the low-resource rural areas where most bites occur, resulting in a high mortality rate. A new oral medicine taken “in the field” could slow reaction to the venom and give patients more time to get to a hospital.
From his base at a hospital in Dharan in eastern Nepal, Bulfone traveled around the country to various health posts, snakebite treatment centers and rural communities to interview potential partners and analyze the possible barriers to conducting a clinical trial of the medicine. He also spoke with snakebite victims and observed patients in recovery.
As he listened to people’s opinions and concerns about the trial with the help of local interpreters, Bulfone came to understand the importance of qualitative data collection. He was especially struck by some skeptical comments that the trial might benefit foreign researchers (or drug companies) more than the people they intended to treat.
Facing the ethical implications of a clinical trial highlighted for Bulfone the fact that outside researchers must carefully design any global health initiative in close collaboration with locals. “We must work with them as equals, and they must benefit,” he said. “Our ultimate goal is to have a drug that works for them.”
Bulfone’s capstone project was marked by serendipity—or as he joked, “serpent-dipity.” After completing his research in Nepal, he had the opportunity to travel to Geneva, Switzerland, to meet with some of his mentor’s project collaborators. While he was there, the World Health Organization announced they were adding snakebite to their list of neglected tropical diseases, a new classification that could help direct more resources toward the problem. Bulfone suddenly found himself at the center of a hot topic, and was able to speak about the promising new snakebite treatment and connect potential collaborators with his mentor back in San Francisco.
Bulfone said he achieved the three goals he set for himself in his capstone project: to learn about qualitative methods, to advance the snakebite treatment project (“I wanted my time to be useful and to make a difference”) and to learn about another culture and become a better communicator.
Observing a health system in a resource-limited area was eye-opening, he said, and he is now considering applying to medical school “because as a doctor you can bring your skills anywhere in the world.” First, he will continue to work with his mentor on developing the clinical trial.
While conducting his capstone research, Bulfone had the bonus experience of an incredible five-day hike in the Himalayas. His only disappointment? He never saw any live snakes.
Read student blog posts to learn more about their capstone experiences in their own words.