Public Health and Epidemiology: My Story

dr_aida_asmelash_public_health_and-_epidemiologyMeet Dr. Aida Asmelash, the Clinical Research Site Leader and Research Associate at the Botswana Harvard Aids Institute. She is an experienced clinical researcher, with exposure to HIV/AIDS Research and several publications on the same. She is also the Network Program Leader for the AIDS Clinical Trials Group (ACTG). This is our interview with this global leader.

Question: Tell me about why you wanted to be a doctor and how you got into public health.
Aida: I have always had a great passion for helping others. Since I was a young girl, maybe 10 years old, I knew that I wanted to be either a nurse or a doctor. I completed high school and got a scholarship to study medicine. After medical school, I was posted in rural Ethiopia where I worked for about a year before proceeding to Europe for postgraduate studies in public health and epidemiology.

Question: Why Public Health?
Aida: First, as I said, I have always had a passion for helping people. The other reason was my training. I was trained in a university where caring for people, like community based care was inculcated in the program. Bedside clinical care was taught together with community care. We were out in the community, doing house visits and seeing the problems that our patients had, such as sanitation and nutrition. From that early stage in my career, I realized that prevention is much more effective than cure. So that is how I was drawn into public health.

Question: How would you describe public health to the layman?
Aida: Public health is concerned with the health issues of the community, understanding what the public is suffering from and trying to prevent that. That is the primary focus of public health. Epidemiology looks at controlling epidemics or outbreaks, disease surveillance and developing models to prevent epidemic occurrences instead of running around after it has happened. Now, when you combine public health with epidemiology, you are able to analyse epidemics and their spread at a community level. For example, when the ebola outbreak happened in West Africa, public health specialists in Botswana together with other professionals were working to prevent entry of ebola into the country.

Question: There are other public health professionals who do not have a medical degree. How do they tie in?
Aida: There are many ways to do public health. Some people don’t need to get medical degrees. There are nurses who do public health, or even psychologists and so on. Combining public health with training in medicine, nursing or any other paramedical training would be fine in my opinion. That way, once you cure someone of the disease, you can, at the same time, understand how they got their disease and go back to the community to try to prevent recurrence.

public_healthQuestion: Public health to HIV, how did you make the transition?
Aida: My postgraduate work in Europe was focusing on non-communicable diseases and alcohol drinking and cardiovascular disease. When I started writing my postgraduate thesis on heavy alcohol drinking,  I found it very difficult to find fulfillment in the work because back home, at that time, a lot of people were dying of HIV. That was early 2000. The whole of sub-Saharan Africa was greatly affected so I felt that I should go back to my continent and get involved in this fight against HIV. I found infectious diseases and HIV more pressing for Africa. So I abandoned my PhD program and came back to Africa, specifically Botswana, which was welcoming to health professionals. My first assignment in Botswana was with the Ministry of Health and Bristol-Myers, a pharmaceutical company who were rolling out antiretroviral drugs. After that, I got the opportunity to join Botswana Harvard AIDS Institute which, at the time, had a big trial on the prevention of mother to child transmission. This was really my passion, protecting mums and unborn infants and I have been working as a doctor and a researcher since.

Question: What is your typical work day?
Aida: I oversee protocols, that is, on-going studies. Protocols are developed either here or elsewhere, and then we look at them and if we think they are relevant for our setup, we apply to be part of the study. Once we get the approvals, we seek ethical clearance from the Ministry of Health which determines if the study is suitable Botswana and the community. Then we present the study to the community advisory boards, to determine if it is culturally acceptable.  Once you get the clearance, you can begin conducting the study. To conduct the study, you have to get participants or volunteers. That involves going out to get volunteers, liaising with the different health centres and hospitals, introducing the study, partnering with doctors to refer patients who may be interested in the study. Once the participants come in, they are screened to make sure they are eligible and then they are enrolled as part of the study. At this point, the participants become our responsibility. We have to make sure their well-being is being taken care of. If they develop side effects, they are treated well. I make sure that the data we are collecting from these participants is of good quality, that it is stored securely in a confidential manner and that timelines are adhered to. So basically, that is how my day looks like. I oversee these activities. I follow up on the reports I receive on patients, perhaps, if they develop some side effect or something like that. I am also involved in recruitment and retention of participants into studies. Once you get them to participate in clinical trials, you have to make sure that they are retained. On top of that, I am also responsible for funding and finance. We are funded by National Institute of Health(NIH) in the United States. Harvard gets the funding from NIH. Harvard is our parent institution. I work together with the finance and grants department to make sure that we get the funding, that we don’t overspend and whatever money we have is used to do the necessary tasks.

Question: What is the most exciting and least exciting thing about your work?
Aida: The most exciting thing is the satisfaction you get when you help someone or the community and you see them well. I can’t even describe that feeling, it is really good. My work is very fulfilling. The least exciting thing is that it can be overwhelming and busy. At times, you work odd hours. The global community is working together to fight against HIV/AIDS so we have collaborators all over the world and you may have to take conference calls late at night.

Question: How many people are currently working under you?
Aida: 70 people

Question: What is challenging about managing 70 people and how do you handle this?
Aida: Human relations is one of the least enjoyable part of the job, that is managing people. The good thing is that upper management, CEO and COO, are very supportive. They have an open door policy and give you all the support you need, when you need it in that manner. Botswana Harvard is also very well organized and structured, with a Human Resource Department, and a grants and finance department, so we work together with them.

Question: What would you advice girls who would want to get into public health?
Aida: It is not an easy task, but it is also not an impossible task. So they need pay attention to whatever they are taught in classes from the get-go. They need to be serious about their studies and once they have that goal, they should know that it is achievable. Nothing is impossible. They should not give up, but try again and again until they have reached their goal.

Question: How do you balance your hectic schedule with work and family?
Aida: Well, that is a little difficult. But as I said nothing is impossible. So even your family should be supportive and will understand that work is work and that you are actually helping people. I have a very supportive husband and that has helped me a lot. I do a lot of travelling both inside and outside Botswana and he has been very supportive. I had to leave my 3-month old baby to attend a meeting for a week, and my husband was taking care of the baby.

Question: What is your favourite quote?
Aida: Y0u must be the change you wish to see in the world!  –Mahatama Ghandhi

Question: How would you define success?
Aida: I don’t think that success is a goal, it is a journey. Every day, the little things, helping others, be it patients or people who are working with you, giving encouragement to others gives me the greatest satisfaction. When people have some issues, just counselling them gives me the satisfaction for the day. So I don’t have a goal of being successful someday, I consider myself successful now. I like to take each day as it comes.

Question: What is your largest fear?
Aida: Maybe, terminal illness or an epidemic that would happen in the world. But I am a believer and a Christian, so I try not to live in fear. I always pray and I think I am fine.

Question: Looking ahead, what is next?
Aida: While working in Africa, I have observed that there are some gaps that we need to fill in health care, health policy and things like that. I think we need more people with the capacity to drive health policy in an ethical manner, that is bio-ethics and health policy. We have gaps and I want to be one of the people to fill that gap. I think that Ministry of health should not be filled by people who are political. There should be people with the knowledge to make decisions in an ethical manner and I intend to be one of them in one of the African countries.

Question: Any mentors or role models?
Aida: My greatest role model is Dr. Shahin Lockman, an associate professor and infectious disease specialist at Harvard Medical School, USA. She is a knowledgeable person who is not afraid of hard work. She is someone who is always willing to help others, has great empathy and sympathy and can identify with the people who are suffering. She comes to Botswana and she is just a regular person, buying food on the streets and while eating, chat with her patients. She has been a great inspiration to me. I think even character-wise, she has helped me change. She is very humble.

Question: Are you mentoring people?
Aida: I hope so. There are some people I have mentored, but it is for them to say that she has been a great mentor. The job, in itself, involves a lot of training and whenever new people are coming in, we train them. I have worked with Botswana Harvard for 12 years, so I have trained a lot of people.

Thank you for chatting with us.

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