January 27, 2020

Through a Burke Global Health Fellow’s Success, her Colleagues’ Careers Blossom

When asked how she began a career in global health, Bethany Hedt-Gauthier thinks back to her experience as an undergraduate mathematics major. “I came to global health via numbers and data,” she says. From 1999-2003 Bethany served as a math teacher with the U.S. Peace Corps in Namibia. “The community where I lived had a 20% HIV prevalence, before any treatment programs were available to that population. I remember feeling very disempowered to address the obvious effects of the epidemic.” After returning from Namibia, Bethany completed a PhD in Biostatistics at the Harvard T.H. Chan School of Public Health, putting her global health research skills to work quantifying gaps in care and evaluating the effectiveness of interventions.

Today, Bethany is an Assistant Professor in the Department of Global Health and Social Medicine at Harvard Medical School (HMS). Between 2012-2015, she was based full-time in Rwanda as Research Advisor for Inshuti Mu Buzima (IMB), Partners In Health’s sister organization, and as a Visiting Instructor at the University of Rwanda. In addition to developing her own research projects, a large part of Bethany’s role involved nurturing the research interests of her colleagues on the ground. Under her leadership, and with support from the HMS-based Global Health Research Core, IMB implemented a suite of research training activities, ranging from introductory series to increase exposure to and use of research in individuals’ clinical and program work, to providing scholarships and mentorship for those in advanced training programs, including Masters and PhD students at the University of Rwanda.

One of the core activities in this program was an Intermediate Operational Research Training (IORT), a yearlong idea-to-paper series that culminates in trainees publishing their first peer reviewed publication. Throughout the year, trainees follow three modules covering developing a research protocol, data analysis, and manuscript writing. Each module consists of five to six days of in-person sessions, with additional support between sessions, lasting two to five months, to complete course milestones. In the face-to-face sessions, the training format includes lecture sessions, open sessions when trainees apply lecture content to their projects with real-time hands on feedback from mentors, and plenary sessions where trainees present work to the larger group of fellow trainees and mentors to receive feedback.

 “[This training] was modeled off of the MSF/International Union Against Tuberculosis and Lung Disease course, now folded under the broader World Health Organization SORT-IT initiative. I went to observe their program and replicated the core components,” Bethany says. These core components included trainees working towards a research publication, receiving instructional in-person sessions and mentorship along the way. “But we also had to adapt to the unique needs of our trainees and the constraints of our training resources. One thing we do differently”, says Bethany, “is train in pairs to build collaborations and encourage peer-to-peer learning. We also provide more extensive mentorship between training sessions.” “Probably the biggest difference”, she says, “is that all of our trainees are Rwandan. Other models focus regionally, where we focus on building national research capacity and collaborations.”   

To further her work, Bethany applied for and was selected to receive a 2015 Burke Global Health Fellowship, from Harvard Global Health Institute. The Burke Fellowship provides funding for Harvard junior faculty members from across the University to support innovative research, and curriculum development and teaching in global health. A core aim of the Burke Fellowship is to help launch and advance the careers of promising Harvard junior faculty, like Bethany, working in global health.

Bethany’s Burke Fellowship research project explored a set of operational research questions related to surgical care in rural Rwanda, all led by first-time Rwandan first-authors trained through the IORT. The Burke Fellowship was “just what I needed,” Bethany recalls, “to strengthen and formalize this training, to get more traction in global surgery research and to demonstrate that research can be produced in parallel with research capacity building efforts.”

Since 2014, Bethany and her right hand, Jackline (Jackie) Odihambo, a Research Assistant, have worked together to refine the training. As a standout high school student in Kisumu, Kenya, Jackie received a scholarship to attend Williams College where she majored in chemistry and acquired an interest in global health research. Jackie supported the 2014/2015 IORT as a research assistant to the trainee teams, and with support from the Burke Fellowship, continued as a facilitator and training coordinator for the 2016 iteration. “Jackie has been a key component for the early success of the training,” says Bethany. “In the process, she not only developed her own research skills, but also skills in teaching, coaching and mentorship.” For Jackie, one benefit of the IORT is “the soft skills trainees acquire over time. Throughout the training, trainees learn to be a team player and to communicate their work. During data collection, they learn to be ethical and adaptable to the needs of their setting. In the peer-review phase, they learn to be patient and persistent, and feel accomplished when they have their paper published.”

Christophe Mpirimbanyi, a young Rwandan surgeon, is a 2016 graduate of the IORT. Christophe’s desire to pursue a career in surgery grew from supporting his father through four surgeries for an abdominal condition. Christophe constantly wondered, “What more can be done for my father?” Today he is the Chief Surgery Resident at the College of Medicine and Health Sciences at the University of Rwanda. Christophe considers himself lucky for the opportunity to participate in the IORT. Rwanda’s Ministry of Health and the University of Rwanda are very committed to research and Christophe’s surgical mentors encouraged him to participate in the rigorous training in spite of the significant time commitment and his busy clinical schedule. “A strength of the training was that we were taught, then immediately practiced what we learned and received feedback. We had a session on descriptive statistics, then we analyzed our data and produced tables—all in the same day.” “These days were long,” Christophe remembers, “and many days, we worked until midnight.”

Christophe’s hard work has certainly paid off— with his colleague Alexandre Nyirimodoka, he has submitted a paper describing the presentation of emergency general surgical conditions to rural Rwandan district hospitals and the surgical care available to these patients. He is also a co-author on another training paper, led by trainee John Ruhumuriza, detailing the costs of providing laparotomy in rural district hospitals, a procedure that is currently only available in a limited number of districts.

“One of the best ways to learn in a surgery setting,” Christophe says, “is through research and asking questions like ‘Can we apply that [finding] to our experience?’” Robert Riviello, Harvard Medical School assistant professor working in Rwanda since 2009 and senior mentor to IORT trainees agrees. “On the clinical side, [learning] means understanding how to be resourceful in different settings— taking scientific results and then using creativity and adjusting to the setting. On the research and investigative side, it means identifying questions and unique approaches that come from our own experience that warrant further exploration.” For example, says Robert, “Christophe noticed necrotizing soft tissue infections in children that may be related to malnutrition. In the U.S., this is not an association we would generally make, because malnutrition is not as prevalent.”

Robert believes that the bidirectional nature of the IORT is the key to its value. “Learning goes both ways,” he says. “This creates an opportunity for our Rwandan collaborators, but Harvard Medical School students, fellows and faculty from the Program in Global Surgery and Social Change (PGSSC) also gain from participating in these trainings. We find that the learning is relational. It’s built on trust and is deeply personal.” He credits his overall experience in Rwanda in helping him become a better surgeon and teacher.

With the goal of a fourth IORT cohort beginning this year, Bethany reflected on how instrumental these trainings have been for her own career development. The first three offerings of the IORT trained 37 emerging researchers, producing nine published papers, eight papers under review and another three in late stage development. The success extends beyond having published papers – in February, Bethany and colleagues submitted a National Institutes of Health (NIH) grant where all of the preliminary evidence pointed to results from IORT research and two of the co-investigators were former IORT trainees. The team plans to submit a second NIH grant this year building off of this work.

These trainings have also built the research careers of her mentees. Christophe is leading his own scholarly work, looking more closely at management of soft tissue infections in rural settings using data generated through the IORT. With funding from the Burke Fellowship, he traveled to Las Vegas in February to present his work on emergency general surgery in Rwanda at the 12^th Annual Academic Surgical Congress, a premier conference for networking on emerging surgical research, and then to Boston to present to faculty and students at Harvard Medical School. Jackie aims for a career in health policy in East Africa, with plans to pursue a PhD within the next two years to further develop her skills. Through her support of this and other capacity building activities, she has over a dozen publications and with funding from the Burke Fellowship, is presenting the IORT program and research results at the Bethune Round Table in Ottawa, Canada in June 2017.

True to the fellowship goals, Bethany’s Burke Fellowship certainly has helped her “launch and advance” her career and has mapped out a professional pathway as she continues as tenure-tracked faculty at HMS. She is proud of her career growth over the last two years, but is perhaps most proud of her trainees–Christophe, Jackie and others. “These colleagues are some of the most dedicated and hard-working individuals that I have ever worked with, and their achievements of publications and invitations to conferences should be noted”, Bethany remarks. “It has been my honor to support them through the Burke Fellowship and have no doubt that this will catalyze ongoing collaborative relationships between Rwandan clinicians and Rwandan and HMS researchers to build and strengthen surgery programs that meet the health needs of the nation they serve.”