SUBSCRIBING TO A HEALTHIER BANGLADESH
What intrigued you to embark upon the journey of a researcher? How did the transition happen and what were the initial challenges?
What truly inspired me to pursue a career as a medical researcher was my exposure to some of the finest international scientists right after my medical graduation. As a medical officer in icddr,b, I was fortunate to work on a couple of vaccine trials; I was working with several leading public health researchers from Johns Hopkins University. For the first time, I realized how satisfying it is to be solution oriented, rather than simply treating a health problem.
While this transition from clinical care to clinical research began during my tenure at the icddr,b, the work was nevertheless tough. Unlike many early-career researchers of today, I had never worked in modern offices in those days. I was based in urban slums and rural communities, often in challenging circumstances. However, it was a flavor of real public health and I enjoyed every moment of it.
What is the condition of health research in Bangladesh? How important is it for the nation? How can it help us shape our healthcare system to meet the challenges of the future?
Enthusiasm towards health research is rising in today’s Bangladesh. Clinicians today are increasingly interested in research, and medical students are keen to learn scientific skills. These are great signs.
Nonetheless, the academic and professional structures of this country are still not entirely favorable to create high-quality researchers. Our education system should primarily be based on innovative research-based education rather than traditional lecture-based teachings. This transition will stimulate scientific intellect and will develop the necessary skills of analysis and be problem-solving from the very outset.
Similarly, progression in professional life should be based on achieving academic and scientific excellence (such as having publications in peer-reviewed journals), rather than simply considering seniority.
Such transformative changes will gradually create a culture of evidence-focused health care system in Bangladesh.
Could you please detail the CAPABLE program? How did the inception of such a massive program happen? What outcome are you looking at?
The CAPABLE program, formed with an $11 million competitive grant from the Global Challenges Research Fund of the Research Council UK, will enable the establishment of a 200,000-person cohort study from across Bangladesh to study long-term health. This program is based on the already-existing collaborations and scientific platforms that I helped to create in Bangladesh. I am the Scientific Director and Co-Principal Investigator of this program.
Bangladesh has had considerable success in cutting child mortality and fertility rate in recent years, but it faces an onslaught of chronic diseases that arise from an interplay of factors ranging from arsenic-contaminated drinking water to iron-deficient foods and from air pollution to the rise of the western lifestyle.
In this regard, CAPABLE will gather data from the cohort and engineers, sociologists, health researchers and a host of other disciplines will try to understand how the risk factors interact – and build a model that can be used to test interventions before they are implemented.
Eventually, we aim to help develop simple, scalable and effective solutions to control major environmental and lifestyle risk factors in Bangladesh. In addition, the CAPABLE program will also train a cadre of 80+ Bangladeshi early to mid-career health researchers to build sustainable scientific capacity in Bangladesh.
What is your take on the rising burden of non-communicable diseases in developing countries? How can a nation like Bangladesh face this problem?
In South Asia, the burden of cardiovascular disease and other chronic non-communicable diseases or NCDs have increased on an unprecedented scale and are expected to be much greater than any other geographical area worldwide.
This overwhelming burden of NCDs has a major economic implication since the majority who suffer from these diseases in this region tend to be young and in their productive age. Among all South Asian countries, Bangladeshis also remain one of the least studied populations with respect to the NCDs. Additional to a significant burden of traditional risk factors for NCDs, this population may be affected by several unique and as-yet-recognised determinants. Therefore, its crucial that we try to understand why this population is at such high risk of these diseases. When we understand the risk profile better, it will then be easier for us to develop preventive strategies which would be simple, cheap, scalable, and locally-appropriate.
Tell us about the outcomes of the BRAVE Study. What needs to be done to reduce the high vascular disease burden among locals and non-resident Bangladeshis?
The preliminary findings of BRAVE indicate that in addition to conventional risk factors (such as smoking, hypertension, high cholesterol, and diabetes), the presence of toxic heavy metals such as arsenic, copper, and mercury in the body may double the risk of heart attacks in Bangladesh.
The study also found a link between fish contaminated with formalin and other chemicals and a heart attack but suggests future studies to confirm the link. Furthermore, we have found that parental consanguinity (eg, when parents are first cousins) increases the risk of heart attacks. Among other risk factors, chewing tobacco, sitting for more than six hours a day and daytime naps were each associated with enhanced risk of heart attacks.
Since it appears that several unique risk factors may increase the risk of heart disease in this population, future generation preventive guidelines in Bangladesh, in my opinion, should consider both “classical” and “local” risk determinants of NCDs.
What advice do you have for young researchers?
Just follow your dreams. Try to get engaged with some research projects early on, even if they are voluntary experiences. Gradually pursue some formal training (such as through a Masters in Public Health or Epidemiology) to gain basic research skills. This will help you to understand, undertake and interpret basic research. Even as a clinician, how to appropriately read a scientific paper is very important, so some fundamental training is very helpful. Then if you are interested in learning further advanced research skills, a Ph.D. in a reputed university should be the next step.
Where do you see yourself in ten years?
In ten years time, I sincerely hope that several major research papers will be published from the CAPABLE research projects, findings from which will then help inform local public health policies. I also hope that I will be able to train a large cadre of early-career researchers to help develop scientific capacity in Bangladesh in a sustainable way.