Preparations are Moving Along:

I have quite a few updates this week!

More on my Fellowship Project

I had a great call last week with Dr. Drew Lewis, who is a Global Medical Affairs lead here at Pfizer, and who has worked extensively with vector-borne disease in the past. He gave me great insight into what I will probably experience in the field in India, and helped educate me on the sort of efforts that have been undertaken in the past to combat malaria. My GHF Program coordinator, Oonagh, joined in the call, and she was able to share a little more about what should be my main project in India.

I will be based in New Delhi, helping CARE India to set up a new program to eradicate Kala-Azar, or visceral leishmaniasis (VL).

VL is a disease caused by a protozoan called Leishmania donovani, and it is transmitted by Phlebotomus, a small sand fly, which bites human hosts much like a mosquito. According to the World Health Organization (WHO), it is endemic in the province of Bihar in India (where I'll be working in the field) and 60%+ of VL cases occur in the Indian subcontinent (including Bangladesh, and Nepal). VL is also prevalent in Brazil and Sudan. In 2010, in Bihar alone, over 20,000 cases of VL were reported (with likely many more unreported), and nearly 100 reported deaths due to the disease.

The disease usually first results in fever, weight loss, and enlargement of the spleen and/or the liver. The name Kala-Azar means literally "Black disease," and the form of VL found in India often results in darkening of the skin. VL is considered to be fatal if untreated, though it is actually the weakening of the immune system, leading to other (secondary) infections, that usually results in death. Because the sand fly and the protozoan are found in rural, poverty-stricken areas of the world, where the inhabitants are typically undernourished and subject to many other diseases (tuberculosis, malaria, and many others) - as well as a lack of treatment - it is easy to see the need for intervention.

There have been efforts in the past to eliminate VL in India, through what is called Residual Indoor Spraying (with insecticides like DDT) coupled with efforts to educate villagers about how to better prevent or limit sand fly bites (bed netting or some kind of screening can be very effective); these efforts have been able to reduce the incidence of the disease for some years, but a renewed effort is needed to finish the job.

My project will be working with CARE (and likely other stakeholders) to establish a new eradication program, establish goals, and determine how best to monitor and evaluate progress over time. I will be making several visits to Bihar, and by the end of my Fellowship will have started a pilot program to put everything into practice. The eradication effort will likely span many years, so key to this is setting up a sustainable system to continue monitoring progress over time.

For more information about Kala-Azar and past attempts to eradicate it in India, click here, here and here.

CARE National Conference, Washington, D.C.

On March 5th and 6th I had the honor and pleasure of attending the CARE conference in DC, joining Oonagh, as well as former GHFellows Melinda (2012), Carrianne and Crystal (2010). On the first afternoon, we attended a reception hosted by the French Ambassador, and had the chance to watch a chapter of the new film, "Girl Rising." The chapter was very moving, very inspirational, focusing on a young girl named Senna in small mining town in the Andes, and how she overcame poverty and many other obstacles to obtain an education and help her family. The film itself is made up of quite a few such chapters, and will be available for limited special viewings across the country (http://girlrising.com/). CARE helped identify several of the girls featured in the film via their local anti-poverty programs.

On the 6th, we attended CARE's program for the day, and it included sessions such as "Telling the Empowerment Story" and "Exploring CARE: Going Beyond the Mission Statement." The most eye-opening part was "Voices from the Field" - Crystal was one of the panelists who described their experiences working in the countries where CARE does most of its work. Fascinating and inspiring stuff.


Getting Visas and Planning for a trip to Dhaka:

On the logistical side, after conversations with my host organization, CARE India, and our Pfizer GHF team, I have been able to make a few more plans, and to get my visas!

The process for getting an India visa was not too tough, as I already had an active one from my business trip to Mumbai last June. I still had to get a lot of information together, including letters from CARE India and CARE USA, and submit travel plans and timing, etc. It took me a couple of weeks to get everything in line - and then I went over to Travisa (the organization to whom the India Consulate has outsourced the provision of visas and other passport-related matters) and submitted it. A couple of days later, I just walked over and picked it up.

I also made plans to go to Dhaka, Bangladesh, for a few days before the start of my Fellowship, to see my dear friend Zubayer (+zulkarin jahangir)! Very excited about this - it's been almost five years now. I bought a ticket from Delhi to Dhaka (2.5 hour flight) a couple of days after my arrival in India (so I have a little time to settle in, hopefully), and Zubayer will be taking care of all the arrangements in-country. Looking forward to it immensely!

The Bangladesh visa process was a little easier than for India (less paperwork, etc), but it actually was tough to submit the documents as they don't allow you to set up an appointment - it's walk-in service and first-come, first-served at the Consulate. Luckily, it's right across the street from my office, so I was able to find a little time to wait in line before work. Their turnaround was even faster - just one day! So I am now in good shape - after a few more vaccinations - to leave on May 24th.