Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.”
When I joined Emory in August 2006 (naive to US academia, never
having written a grant or supervised a doctoral student), I was suddenly a
single member team with an office, and without the national diabetes
research operation (and security of a federal job) that I had just left
behind.
Going to my new office every morning at 7.00 am, I would sit and
stare at a white board to chart ideas, and spent my first 3 months or more
talking to people (at Emory and several other places) to get advice on what I
might do and how.
I was very lucky to get some phenomenal and inspirational advice
and support from the likes of Bill Foege, Jeff Koplan, Jim Curran, Rey
Martorell. They simply gave me inspiration and none of them told me what to do
or what not to do.
My life was suddenly like an empty canvas on which I could draw
anything. This was a very exhilarating feeling, and one that I long for! What a
lovely idea - a vast landscape ahead, no restrictions, and one could do
anything with the freedom to shape something and to fail or to succeed (on
one's own terms).
Equally, in my various meetings, I met people
("experts", and "colleagues") who gave me advice (some
unsolicited). Many of these was about barriers, challenges, and what I should
and should not do. I would prefer not attributing these items (although,
I fully remember who said what and when). Some examples below:
• “Getting global NCD (diabetes studies) funded is close to
impossible. Gates is not interested. NIH won’t fund them. LMICs don’t have
funds.”
• “Finding good fellows and faculty to work on global NCD will be
hard; there is no career path for them.”
• “We don’t need research in Low and middle income countries
(LMICs). We just need programs to implement all the science we have.”
. “Emory has no strength in diabetes, only one NIH-funded diabetes
researcher. You should focus on other diseases”
• “Emory has no track-record in global NCDs. You should join
hands with the Harvard team and slowly grow your program.”
• “India is a very difficult country to work with. NIH has
struggled. The country has too many restrictions, is proud and arrogant, and it
is much easier to do work in other countries like China, countries in Africa,
in other parts of Asia, or Latin America.”
• “All of diabetes is obesity-driven, and Indian populations are
highly insulin resistant.”
• “Quality of care cannot be improved in LMICs until the
governments invest in infrastructure.”
• “Interventions and quality improvement strategies that work in
high income countries don’t work in LMICs.”
• “We should only focus on prevention of diabetes and NCD, as the
LMICs don’t have the capacity to deal with care and will be overwhelmed.”
• “Only prevention that can work is societal and governmental
action.”
• “Industries are the cause of NCDs, and public health should not
collaborate with them”
• “We should only work with governments, not with private
institutions”
• “Our focus in LMICs should be prioritized toward the poorest and
least served areas, not big cities or strong institutions.”
• “Technology is the cause of health inequities, and public health
should stop their growth.”
• “We should train large numbers of foot soldiers in LMICs, not
doctoral and post-doctoral fellows or faculty researchers.”
• “Starting schools of public health in LMICs is risky. There wont
be jobs for these people.”
• “Infectious diseases and undernutrition should be eliminated
before we address NCDs in LMICs.”
• “Globalization and westernization are the “causes” of NCDs, and
we should fight to stop them.”
Looking back, we seem to have turned every one of these barriers
or negativisms (above) into opportunities!! Of course, I was so lucky to
be surrounded (in due course) by some amazing colleagues (faculty, fellows,
students), and special thanks to all of them (only a handful of them are
tagged; there are far too many to name them all).
