This interview was first published Sept. 21, 2010.

Amy Bei, age 29, is a doctoral student in the Department of Immunology and Infectious Diseases at the Harvard School of Public Health.

The former Santa Rosan (Montgomery High class of 1999) earned her undergraduate degree at Harvard in biochemistry. She also has volunteered in a shelter for street boys in Tanzania; served as captain to the Harvard fencing team; was a pole vaulter on the college’s track and field team; and has taken training for her pilot’s license. She loves world languages, learning Wolof, Kiswahili, Spanish, Portuguese, Italian, and elementary Amharic, Arabic and Somali. Besides being published with colleagues in medical journals, she has conducted overseas research, both in Tanzania as a U.S. Fullbright fellow and in Senegal.

THE INTERVIEW:

1.  How did you get interested in learning about a disease like malaria?

I first was introduced to the world of tropical diseases in the laboratory of Dr. Jim McKerrow at UCSF.  In his lab, I studied schistosomiasis, a disease I had never heard of, largely because it only affects people in developing countries … Schistosomiasis is a disease caused by a parasite with a very complex life cycle… I found parasitic diseases fascinating from a scientific perspective, but I also was interested in pursuing research in the field because while (these diseases) pose an incredible global health burden, they are largely underfunded, and even “neglected” in the research field.  Additionally, the members of the lab came from all over the world – everyone united in their resolve to discover the mechanisms by which these parasites cause disease – and I enjoyed being surrounded by such a talented and international group of colleagues.

2.  What are your long-term aspirations?

I have decided to focus my career on international research. I feel that the best way to develop new tools that can aid in the treatment or prevention of diseases like malaria is to integrate laboratory and field-based approaches. My long term goal is to continue conducting cutting-edge science where the disease is endemic, or native to the country. I also hope to contribute to the training and encourage the professional development of local researchers.

3.  Why do you want to pursue this career? What is it that excites or attracts you?

There are many aspects of tropical disease research (and specifically malaria research) that excite me. Parasitic diseases are both biologically fascinating and challenging from a public health perspective because they are masters of surviving within us, and have developed tools and weapons to fight back the many ways we try to kill them, either through our own immune responses or with chemotherapeutic agents. Additionally, I feel that there is a tremendous need for people to pursue research in neglected tropical diseases. There is a need for people to be a voice and an advocate for those who suffer from the disease, to help influence global awareness and influence health policy.

From a personal perspective, I enjoy the tremendous challenge of working in an endemic setting on such a complicated disease. Ever since I was a child, I loved tackling challenges. Malaria research alone is difficult, but pursuing research in areas that lack the necessities we take for granted in the Western world is even more challenging. I enjoy having to come up with creative solutions to solve the problems necessary to make headway in the research.  It’s very demanding, but when you succeed, you feel a tremendous sense of accomplishment having succeeded despite the obstacles!

4.  Could you relate an experience that has stuck with you?

When I arrived in Tanzania, I spent the first few weeks traveling with two Tanzanian graduate students to remote village dispensaries trying to find an appropriate site from which to recruit malaria patients for my study. It had to be far enough away from the city that there was high malaria transmission and people weren’t self medicating (buying drugs from local pharmacies without seeing a clinical worker) but it also couldn’t be too remote so that the parasites in the blood which was drawn from the patients would die as we traveled along tiny roads full of potholes and mud to get back to the research laboratory. At one of these dispensaries, a woman came in with her daughter who was burning with fever, had difficulty breathing, was anemic, and was becoming non-responsive. When her blood was examined on the microscope slide, it was full of parasites. She was diagnosed with severe malaria and was referred to the local hospital for quinine (the treatment reserved for very severe malaria cases) and a blood transfusion.  Her mother sadly nodded and they left. As we were on the road to another site, one of the grad students told me, casually, that the girl with severe malaria would die. When I asked him how this could be (since she had had a diagnosis and had been referred for emergency treatment) he explained that she came from a far-away village.   They waited many days to come to the dispensary for diagnosis because it was such a long journey, and so the malaria grew worse as the family waited. To get to the district hospital was a bus ride away and once there, they would have to pay for food, lodging for the mother, etc.  He said that they couldn’t even afford the bus fare and that they wouldn’t go.  He explained to me that this was the reality for so many people – even when the medicines are free and subsidized by the government, gaining access to the medicine is often the biggest problem.   This realization has stuck with me because it has helped me realize that even with the best tools – a drug with no resistance, a 100% effective vaccine – if we can’t get the treatments to the infected individuals, malaria will continue to be a problem.  In addition to basic research, we need to work on improving health care infrastructure within affected countries so that life-saving treatments can be available to people who live even in the most remote village.

5.  Can malaria be eradicated? What would it take?

Malaria eradication will definitely be a challenge, but we have to believe that one day it will be possible. It is the goal that we all work toward. One aspect of the disease which continues to surprise me is the ease at which is adapts and is able to avoid our attempts to eliminate it.  For this reason, it is very important to develop new and effective tools like drugs and vaccines to combat the disease. However, perhaps equally important is that we thoughtfully and strategically employ the useful tools that we already have to make progress in prevention and treatment and that we use them in a way that doesn’t undermine the eradication effort.

One important factor in the feasibility of eradicating malaria is realizing that right now there is no “magic bullet” – there is no one tool which will eliminate malaria in every country in which malaria is endemic. Differences in the disease dynamics make a single-focused approach unlikely to succeed.  Taking the simple example of insecticide treated bed-nets, while these nets may be effective for malaria prevention in Sub-Saharan Africa (where the mosquito species that carry malaria feed at night and in homes), these same nets may have little impact in regions of the Amazon (where the mosquitoes that transmit the disease feed during the day and in the jungle).  It is important to be aware of these region specific differences when making policies for malaria control. It is also important to employ creativity in tackling the disease, and this is one aspect of conducting scientific research that truly appeals to me.

6.      What lessons have you learned along the way?

One thing I have learned while conducting research in different countries is that cultural sensitivity goes a long way. Often those of us from the Western world believe we have all the answers and think we can solve problems with a decidedly Western approach.  Being aware of local solutions to local problems is important when building lasting collaborations as well as when thinking about sustainable ways to tackle public health problems.