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Michael J. Boivin with Neuropsy Assess Team |
I spent the 2003-2004 academic year at Makerere University in Kampala, Uganda as a Fulbright Scholar in the African Regional Research Program.
The Fulbright Congo experience was life changing for me and my family, and planted the seeds for me to eventually return as a Fulbright researcher to Uganda during the 2003-04 academic year. This time, I focused on evaluating the long-term neuropsychological effects of pediatric cerebral malaria (severe malarial illness accompanied by coma and often seizure). Severe or complicated malaria is the leading cause of hospitalization, mortality, and morbidity of children under age five in sub-Sahara Africa. In East Africa alone, malaria-related annual mortality stands at 70,000 to 110,000 under-five deaths, making it the leading cause of death in this age group.
Despite the fact that malaria is one of the biggest killers of children in the tropics, we do not really know how malarial illness progresses to cerebral malaria in children. We also do not understand the principal mechanism for subsequent brain damage and the neurological and neuropsychological sequelae of this disease. During the acute phase of illness of our malarial study children during my Fulbright year, we did a careful clinical, neurological, immunological, and neurodevelopmental assessment. With the support of additional intramural grant and NIH funding, we have continued to follow those children to the present time.
Our study was based at Mulago Hospital, the national referral hospital for Uganda and the principal teaching hospital for the Makerere University School of Medicine. As part of the capacity building necessary for my Fulbright Scholar project, we established the Severe Malaria Research Center in the Pediatrics Department at Mulago Hospital. We were able to establish this research center during my Fulbright year with the support of an NIH Fogarty “Brain Disorders in the Developing World” program grant (TW06794-01), and have continued to receive intramural and extramural grant support to continue research and treatment at our center up to the present time. Furthermore, our center now supports the neurodevelopmental assessment and medical follow-up of both malarial and HIV-affected children enrolled in NIH-sponsored research through other American university partnerships with Makerere, including the University of Minnesota, the University of California – San Francisco, and the University of Michigan.
The day after arriving in Uganda I hired a research assistant, Paul Bangirana, who had just completed his master's degree in clinical psychology at Makerere University. Paul has continued as project manager of our Severe Malaria Research Center and is presently enrolled in a Ph.D. program at Makerere University through the Department of Psychiatry. Because of our work together, Paul is determined to become Uganda’s first clinical neuropsychologist. His doctoral program is being sponsored by the Karolinska Institute of Sweden. Paul’s doctoral thesis will focus on the computerized cognitive rehabilitation training of cerebral malaria survivors, and preliminary work for his thesis is already underway.
Dr. Robert Opika Opoka is the principal clinical care pediatrician for our center and this past year completed a Master’s in Public Health degree at the University of California-Berkeley. Both Paul and Robert, along with Dr. Justus Byarugaba (pediatric neurologist for our center), have co-authored a number of published research articles and presentations pertaining to our severe malaria research during and following my Fulbright year. It has been most gratifying to see their professional training, international travel, and research career opportunities blossom in the aftermath of my Fulbright year. Dr. Richard Idro, another of our Ugandan pediatrics collaborators during my Fulbright year, has become the leading African researcher in the neurological effects of severe malaria. He is completing his Ph.D. research at the Wellcome Trust Tropical Disease Research Center in Kilifi, Kenya, and has numerous recent publications in leading medical journals including a both a research and a review article in the Journal of the American Medical Association (JAMA).
Midway through our Fulbright year, my wife and I, and our two secondary-school children (Matthew, 14, and Marjorie, 16) were joined by our oldest daughter, Monique. Monique completed an internship in home-based medical support for HIV children and training for HIV/AIDS treatment programs in Uganda as part of her undergraduate degree program. These practicum experiences inspired her to go on to complete her Master’s in Public Health at the University of Michigan within two years following her time in Uganda with us. Since completing her MPH degree, Monique’s work has primarily been in Africa, doing monitoring and evaluation of UNAIDS-sponsored ARV treatment programs. Over the past two years she has done public health work in Swaziland, Malawi, Uganda, Rwanda, Mauritius, and the Sechelles. Our second daughter, Marjorie, completed her junior year of High School during our Fulbright year and returned on her own to Kenya for her senior year of High School. She has also continued to travel, with plans on doing a semester abroad in the Netherlands this coming year. Our Fulbright experience as a family certainly has influenced their educational interests and life calling.
As I look back on my Fulbright Scholar experience in Uganda, I have a deep sense of satisfaction and gratitude. Despite the many challenges and struggles along the way, my Ugandan colleagues and I performed important neuropsychological research, and established the foundations for a Severe Malaria Research Center at Mulago that has continued to expand its scope of work. We also provided medicines, supplies, and a quality of care to our project kids at a significantly better level than what might otherwise have been available to them. Finally, we integrated neuropsychological science with the clinical medical care of children within the context of an important public health problem, which will hopefully make a difference for future generations of children in Africa in malaria-endemic regions throughout the developing world.
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