Date: March 8, 2022 By: Jacquelyn Clermont
Dr. Krista Dong calls her location in Umlazi, outside of Durban, South Africa, the “epicenter of the epicenter” of HIV infection, and it’s there that this Ragon Institute researcher and doctor is making a difference … for science and for humanity. With a medical degree from Brown University, about 32 research papers, and more than 1,000 citations, she rates herself as a “pretty good” doctor, but, she says, “My magic power is designing clinical studies that allow investigators to test cutting edge science … taking research from the ‘bench to bedside’ to address a pressing need.” In South Africa, where her work has focused largely on HIV and TB for 20 years, she combines clinical research with social interventions designed to address issues that put patients at increased risk HIV infection and limit access to life saving treatment for those who are already infected.
Today she is also working on five different clinical studies, including a trial testing a novel product aimed at reducing HIV risk acquisition among adolescent girls and young women. Because women are underrepresented in HIV prevention and cure research globally, she is driven to address this simple inequality.
Dong, who studied chemistry and fine art as an undergrad, has always had one foot in science and the other in design, so it’s no surprise that she stops in her tracks to get at the root of a problem, is unafraid of changing course, and knows how to turn insight into solutions that draw from her seemingly disparate background.
All too often the insights came in the form of heartbreaks. And sometimes the solutions mean dramatic changes in course. The death of multiple friends from AIDS in the early 1980s led her to return to school to study immunology so she could work on a vaccine for HIV. The next turn in her career came while working in the virology lab at the Medical Research Council in the Gambia, West Africa. After watching countless patients die from HIV, TB and malaria, she enrolled in medical school at Brown University. Working in underserved communities, whether in the U.S. or in developing countries has been a constant throughout her career. And in South Africa, when a young AIDS patient opted for suicide over continuing lifesaving ARV drugs he believed went against his family’s traditional beliefs, she realized she had a lot to learn. “I can’t be effective caring for patients in this country if I don’t understand what they believe,” she says.
More than 80% of black South Africans visit a traditional health practitioner before seeking care from their local clinic or hospital, though patients are routinely discouraged by doctors and nurses against using traditional herbal treatments. “My patients would deny having visited a traditional healer, or ‘sangoma,’” Dong says, even while the patients had bracelets and scarification that indicated they followed traditional practices. Fighting against deep cultural beliefs as a part of promoting acceptance of HIV and TB treatment seemed like the wrong approach to her. It wasn’t long before she came to view sangomas as “underutilized allies” in the fight against HIV.
So far, through the Ragon’s ITEACH (Integration of TB in Education and Care for HIV/AIDS) program, Dong and her team have certified over 500 traditional health practitioners to deliver HIV counseling and testing services. The ITEACH program places sangomas in local clinics as a part of the training, where healers are able to offload busy healthcare workers while gaining a clear understanding of how the clinic operates. “While at the clinic, they don’t practice traditional medicine, but they are perfectly positioned to answer questions about how to navigate the dual health care systems and to encourage treatment adherence,” Dong explains.
“They take the time to listen to patients and understand and respect what the patient believes, which is a powerful way to get patients to take to treatment”, she says. Sangomas taught her “the importance of looking at the whole patient.”
ITEACH is not the only Ragon program Dong oversees. The AIDS epidemic in South Africa is caused by a combination of factors, in particular poverty and gender inequality that disproportionately affects women. Dong helped design the nine-month FRESH (Females Rising through Education, Support, and Health) program. Sponsored by the Ragon, the FRESH clinical research site was developed to allow study of the immune response immediately after HIV infection. But in addition, the FRESH program uniquely incorporates a job-skills and empowerment program for the young women who join the research. The program includes intensive HIV prevention efforts combined with frequent monitoring for HIV infection. For any who become HIV infected despite prevention measures, they are provided with immediate treatment and are well positioned to join upcoming trials including those focused on HIV cure. Dong says over 80% of FRESH graduates secure a job, internship, return to school or start their own business within a year of completing the program, which is no small achievement in a country where the unemployment rate is about 35%.
Despite her career’s many turns, there has been one constant: facing the immense challenges of working in underserved communities, whether in the United States or in developing countries. Dong considers herself lucky; working long hours and always personally invested in her work, she waves off warnings of burnout. After two decades, she still feels she has been “blessed” and draws solace and inspiration from one of her heroes and former mentor, the late Dr. Paul Farmer, who tirelessly fought against poverty and health inequity and drew a roadmap for a generation to do the same. “Living a life in service of others is enough,” she says, “but being lucky enough to incorporate cutting edge science is a cherry on top.”
This article is the first in our Ragon Women Make a Difference series, which was created in honor of International Women’s Day and Women’s History Month 2022. Stay tuned for profiles of an ITEACH sangoma and other Ragon-affiliated women making an impact in STEM and related fields.
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