How did we get here?
As our first year of medical school came to an end, we both knew that we wanted to spend our MS1 summer doing something meaningful that combined our shared passions for global health, infectious diseases, and traveling. We linked up with researchers in Teresina, Brazil who were studying Visceral leishmaniasis (VL), a neglected tropical disease prevalent in northeast Brazil. VL was briefly covered during our MS1 microbiology course, but since it is not commonly found in the US, our exposure to it was very minimal. We thought this would be perfect opportunity to learn first hand about this endemic disease. After applying for several research abroad scholarships and putting together two research proposals with our PI in Brazil, we found ourselves with roundtrip tickets to Teresina, Brazil for the duration of our summer!
Our research took place at the Instituto de Doenças Tropicais Natan Portella, IDTNP, a public infectious disease hospital in Teresina. The hospital is the referral center for VL in the state of Piauí and surrounding states so we saw many new cases of VL everyday. Our typical days consisted of working on our individual basic science projects investigating new diagnostic methods for VL, as well as shadowing our PI in the hospital. Although VL is a treatable disease, there are many barriers to providing effective treatment in places where this disease is endemic. In Teresina, children are a particularly vulnerable population with increased mortality. However, the vulnerability of children is not well understood and current literature lacks clinical descriptions of fatal pediatric cases making it difficult to understand the true barriers to effective treatment.
So in addition to our independent diagnostic projects, we tag teamed on a joint project that entailed providing a vivid clinical description of 10 pediatric patients who died from VL at IDTNP. We translated the medical records of these ten patients from Portuguese to English and pieced together the clinical progression of this disease in each patient. After returning to the US, we continued working on this project throughout our second year of medical school and began writing a manuscript.
This past fall, our Brazilian PI contacted us with the opportunity to submit our work to the 6th World Leishmaniasis conference in Toledo, Spain in May 2017. Not ready to let go of our work on Visceral leishmaniasis just yet, we put together an abstract that was then accepted for a poster presentation at the conference. MAA made this one-of-a-kind conference and experience a reality for us by sponsoring our flights to Spain.
The Conference: World Leish 6
The World Leishmaniasis conference occurs every 4 years in a country where Leishmaniasis is endemic. It brings together over 1,000 researchers (both veterinarian and medical) from all over the world to discuss the science, politics, public health and humanitarian efforts of this neglected tropical disease. This year it was held in Toledo, Spain, a historic and beautiful city about 45 minutes from Madrid (see photos attached). Our PIs, lab colleagues and veterinarian friends from Brazil were in attendance which made the experience a great way to reconnect, practice our Portuguese, and continue our research collaborations with our Brazilian colleagues.
Apart from our individual presentation and the presentations of our lab colleagues, we attended multiple lectures during the conference and found a panel on Conflict and Leishmaniasis to be one of our favorites. Cutaneous leishmaniasis is very prevalent during conflict and wartime and has long been a concern for the American military working in Afghanistan. The talk focused on multiple countries and conflicts, two of which we highlight below:
- Columbia - In 1980-90s Columbia, Cutaneous leishmaniasis (CL) was associated with guerilla warfare and the cocaine trade. In the talk, the speaker explained that when the guerrillas hid in the jungle, sandflies would bite them and spread the disease. The association went so deep that CL was called the “disease of the guerilla” and people were associated with the guerilla group if they presented with a CL lesion. Glucantime, the treatment for CL in Columbia, because a weapon of war; it was restricted from being sold generally in order to combat the guerrillas. Once the army started tracking guerillas into the jungles, they also came down with CL. The country saw a huge increase in incidence of the disease leading Columbia to become the country with the 2nd highest number of CL cases in South America, after Brazil.
- Syria - There has been a 3 fold increase in cases of CL since the beginning of the current conflict in Syria. This is due to 1) disruption of health care facilities, 2) population displacement, 3) increased risk of transmission with destruction of buildings, lack of waste control, and increased prevalence in refugee camps, all of which create a favorable environment for sandfly breeding.
At the conference we also enjoyed a round table discussion that brought together masters and students to discuss some of the most important important problems facing leishmaniasis today. Our PI from Brazil was one of the masters. The students discussed the importance of collaboration between researchers, patient and provider education, and increased awareness of the disease in medical schools. Audience participation was encouraged and enabled an interesting discussion of public health, science and politics which we thoroughly enjoyed.
We had the opportunity to stay in Madrid and Toledo for almost one week giving us ample time to experience many aspects of the Spanish culture. From tapas, paella, and patatas bravas (Alex’s favorite) to spanish art at the Museo del Prado and salsa - we loved every minute of this cultural immersion.
We could not be more grateful for the financial support provided to us by the Medical Alumni Association in order to have this experience. The ability to meet researchers and physicians from so many different countries with such differing experiences of Visceral leishmaniasis was eye opening, and has fueled our desire to further pursue global health and infectious diseases in the future.