When Dan Kelly, a young doctor, arrived in Sierra Leone in July, he had no idea just how handy his clinical research skills would be.
His intention was to use his Fulbright Program fellowship to hone those skills by tracking the treatment of HIV/AIDS at a small, community-based organization that he had helped start on a previous visit to Sierra Leone. The group provides health care to amputees and others disadvantaged by the country's long history of war and poverty.
HIV/AIDS is a growing concern in postwar Sierra Leone, one of the world's poorest countries, with seemingly bottomless health-care needs, but the factors that influence the success of treatment are poorly understood, Dr. Kelly says.
Soon after arriving, he found himself sitting in the office of the director of the National HIV/AIDS Secretariat, who asked for his help in preparing a proposal to the Global Fund to Fight AIDS, Tuberculosis and Malaria for funds to study drug resistance.
Now, in addition to carrying out his own AIDS research, which aims to shed light on why large numbers of people diagnosed with HIV/AIDS drop out of treatment, Dr. Kelly plays the less formal role of giving technical advice and helping to develop research proposals and to design programs for the government, whose response to the disease is hampered by a desperate shortage of skills.
"There's a lot of research being done on HIV/AIDS internationally, but it doesn't translate to the culture of Sierra Leone," says Dr. Kelly. "Because I'm the only guy doing research here, I also see my role as working with the ministry of health to develop research capacity."
From early on, as a student at the Albert Einstein College of Medicine, in the Bronx, N.Y., he knew he wanted to work in Africa. During medical school, he worked in the college's student-run free clinic and struck up a friendship with a classmate, Issa Toure, who had fled the war in Sierra Leone and introduced him to that country.
Rather than take the customary year off between college and medical school, as many doctors in training do, Dr. Kelly took a year off between his third and fourth years of medical school, "so I would have enough training to be useful," and traveled to Sierra Leone on a global health fellowship.
Keeping Track of Patients
His mentor during the fellowship, Mohamed Bailor Barrie, a friend of Dr. Toure, was a young doctor who was passionate about providing health care for the poor. Dr. Barrie's dedication to community-based work appealed to Dr. Kelly, who wanted to conduct research that would help the government find ways to scale up community-based public health programs to a national level.
Together the two doctors formed Wellbody Alliance, an organization located in the rural community of Kono. Dr. Kelly at first aimed to conduct his Fulbright research there, but soon realized that he would be better positioned to collect data from the HIV/AIDS clinic at Connaught Hospital, in Freetown, which has around 2,000 patients enrolled in treatment and is the country's largest treatment site.
Now he travels back and forth between the two sites and juggles a handful of research projects, involving issues such as tracing people who are enrolled in treatment programs and studying whether cellphones can be used to help improve patients' adherence to antiretroviral drugs. "I ask patients questions about their social support, their wealth status," he says. "We are trying to understand what are the risk factors and the barriers to treatment, so that we can keep people in care and do a better job of using Global Fund money."
He completed his internal-medicine residency at the Baylor College of Medicine, in Houston, and upon his return will begin an infectious-disease fellowship at the University of California at San Francisco.
Improving HIV/AIDS treatment is important not only for its own sake, he says, but also because the availability of international funds for managing the disease offers the country the opportunity to build models that can be applied to other areas of health care.
In Kono, for example, he is working with a software engineer to develop an open-source system for electronic medical records.
Eventually, Dr. Kelly hopes that his Fulbright experience will help to pave the way for him to become a researcher based in Sierra Leone and affiliated with the John E. Fogarty International Center at the National Institutes of Health, a prestigious posting which requires five years of international public-health research experience.
"Fulbright is providing me an opportunity to prove that I can do research in Sierra Leone," he says, "which is hopefully acting as a conduit for me to come back."