Rob Ragotte describes his experiences on rotation in Ho Chi Minh City, Vietnam.
When I accepted my place in the IITM programme in February 2016, I prepared myself for what I thought would be an interesting, illuminating, exciting, challenging, stressful, and sometimes demoralising few years. What I did not prepare for was wandering around a grocery store for an hour unable to identify a single food I could confidently cook. I did not imagine myself cruising through the streets of Ho Chi Minh City on the back of a motorcycle. And it never crossed my mind that the words cảm ơn (thanks) and không đường (no sugar) would be essential additions to my vocabulary.
As part of the IITM programme, all first year students undertake three lab rotations. For many, this will allow them to get comfortable in three different labs around Oxford where they will learn new techniques and refine their research interests.
However, students are also able, and encouraged, to explore labs at one of Oxford’s major overseas programmes. This allows students to travel to Bangkok, Thailand; Ho Chi Minh City, Vietnam; or Kilifi, Kenya, to work at the Oxford/Wellcome Trust centres situated in those cities.
For my third rotation, I opted to go to Ho Chi Minh City, to work under the supervision of Prof. Stephen Baker at the Oxford University Clinical Research Unit (OUCRU). The goal of my project was to understand the genetic factors that enable Klebsiella pneumoniae, a common and normally harmless bacteria, to cause disease in otherwise healthy individuals. K. pneumoniae can sometimes cause life-threatening infections if it enters the bloodstream or brain.
For the project, I analysed the all the genes contained in 83 suspected K. pneumoniae samples isolated from patients with infection of the blood. Although I had limited experience doing complex computational analyses before, I quickly found myself mastering a host of new skills needed to carry out my project.
I found an abundance of genes transferred from other disease-causing bacteria, as well as genes that confer resistance to a range of antibiotics in the blood isolates. This might help to explain why K. pneumoniae sometimes causes disease and sometimes does not.
While working on this project, it was not immediately clear to me why I needed to be in Vietnam. After all, most of what I did was computer based and much of my day-to-day supervision was via email. My physical presence in Vietnam seemed unnecessary. I could just as easily do my work from Cardiff or Calgary. So I thought.
As my project progressed, I realised not only was it beneficial to be in Vietnam, it was absolutely essential. By living in Vietnam, albeit briefly, I began to understand some of the unique challenges faced by clinicians and scientists alike. The realities of clinical care in a middle-income country profoundly impact not only the type of research that is conducted, but also the how we think about and implement potential solutions. It is not enough to merely identify a problem from afar. Though antimicrobial resistance is particularly problematic in Vietnam, it is not localised to single region, country or continent. It is a global problem and requires global partnerships, coupled with a mutual understanding of the specific goals and challenges, if it is to be solved. My immersive experience emphasised and contextualised the importance of conducting research on a major global health problem.
I do not mean to suggest that I now understand the intricacies of the Vietnamese health care system, or the particular nuances of operating in a middle-income country. I know very little. However, some of the unknown unknowns have now become known unknowns, which is a substantial improvement. Recognising that there are fundamental differences between conducting health research and providing clinical care in a middle-income setting will ensure conversations about global health interventions evolve from paternalistic to empowering. It will allow us to move from a prescriptive approach to one where local idiosyncrasies are considered.
My time in Vietnam was not as orderly as I initially envisioned. Certainly there were challenges and it was, at times, tumultuous. Though, I was fortunate to have an excellent supervisor and resourceful colleagues that ensured I was both productive in my work, and enjoyed my Vietnamese experience. I fly back to the UK grateful for the opportunity and optimistic about the next three years.
Author: Rob Ragotte
Rob is an IITM student entering his second year of the programme.
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