Ewald, Erin

Public Health



India - Characterization of tuberculosis among adult patients admitted to the Sassoon General Hospital, Pune, India

The epidemiology of tuberculosis in India is vastly different than regions of the world where HIV is the primary driver of the epidemic. In India, the epidemic is driven by social determinants of disease, including, tobacco exposure, diabetes prevalence, indoor air pollution, and malnutrition. However, the relative contributions of these factors is not very well understood. We will be launching three studies involving TB cohorts om Pune, India, an active JHU-India colloaborative site for 20 years. These studies will assess the impact of diabetes, indoor air pollution and other modifiable risk factors in adults ad children in Pune, India. We will also be assessing the pharmacology of TB drugs in hair of HIV-infected and uninfected children. Students will have the opportunity to work with the India-based team during the summer in one of these studies.

Erin Ewald

GHEFP Reporting Requirement – Narrative

            I never used to be able to handle spicy food – now, thanks to a summer in India, I can! When I first arrived in India, I was surprised by all the usual things – the heat, the traffic, the food, the crowds, etc. But once I got used to those things and settled into a routine, day-to-day life was fairly easy. I’d get in a rickshaw, go to work, go to the gym, and then come home and eat and relax. Each weekend, I’d try to go to at least one new place – Aga Khan Palace, Shaniwarwada, a Ganesha temple, the college-town area, and many others.

            Working in India took a bit of adjustment – the pace is a little slower, and it’s actually the first place I’ve ever worked where everyone takes a break for lunch! I worked the clinical trials unit at B-J Hospital, which is a public hospital in Pune where my advisor has collaborators. For about the first month of my stay, I was finishing up the JHU IRB – which meant that I was living in two different time zones. I would do as much work as I could, and then e-mail the updates/questions to my advisor or the IRB… and then I would have to wait until the following day to begin again. I think this is one of the most important lessons I learned – in order to be most effective and most efficient while abroad, it’s best to have IRB approval (both local and Hopkins) in place before getting there. I sent in my application as soon as I possibly could (we had to wait for a certificate of translation from the local IRB before submitting the Hopkins one), and waiting for approval still took about half the time I was in Pune.

            Another lesson I learned is that when you enter into another environment, you have to adapt to their ways of doing things – there are different hierarchies that existed in India than I was accustomed to, and at times it felt like I was existing completely outside of the environment in which everyone else was working. Language generally was not a barrier in my situation – everyone working in the hospital knew English and I had very little trouble communicating. However, there were still moments when the language was a barrier; when everyone else is able to communicate more efficiently in Marathi, my co-workers would often use that when not speaking directly to me. But my co-workers were good at keeping me in the loop, regardless of the language information was conveyed in.

            In terms of my future career goals, I feel like I got one part of the puzzle – I experienced many delays in my study approval (my study actually still hasn’t been approved to this day) and learned how to work in a setting that is very different from the U.S. However, my plans to do a study did not pan out – I am very familiar with the approval process now and was able to train one counselor for my study along with designing a questionnaire, but was not able to collect any data or interact with patients. In some ways, I feel that this experience was incomplete, and would like to go back, if not to India than to another global location, to get more experience in actually conducting research, collecting data, and analyzing data. I also made some very valuable contacts in India; I am now working with one of the biostatisticians from Pune on my thesis project. I am very glad I had this opportunity to see what life and research is like in developing countries, and feel much more informed now than I was when I left.

            For other students considering applying to similar experiences, my biggest piece of advice would be to make sure that all IRB approvals have been completed before you arrive in the country. My project required three approvals, and when I arrived only one was in place; even when I left the country, I was still waiting for the last approval. Another piece of advice would be to try to have multiple things to work on, or have something worked out with a supervisor in the country you are going to so that there will be enough work for you to do. All in all, I am very grateful to have this opportunity, and it will be something I will carry with me for the rest of my life.


May 2021



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