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What I like about the field of infectious diseases is the interest range that the field demands. It requires an understanding of the complex interactions between people and the organisms that cause infections. However, it also requires an interest in psychology, anthropology, economics, politics, and history - almost nothing is irrelevant, and there's always more to learn. That is because the infections a person acquires depend upon many aspects of daily life: where he goes, what people, animals, and insects he meets there, whether he can afford to see a doctor, whether the drugs she gives him are counterfeit, whether he kayaks, whether he has a pet iguana.
In the UK, medical studies start right away in the first year of university, but we do not see any patients until the fourth year. After three years, I felt comfortable with laboratory science but apprehensive about being in a setting where mistakes might have serious consequence for people's health. So I arranged to slow down my clinical studies by incorporating a Ph.D. in the middle of my training and studied the virus that causes cervical cancer.
At the same time, I was spending time onwards and became comfortable with the hospital environment. I realized that it is quite rare to make risky decisions in medicine and that when in doubt, there is almost always enough time to talk to someone with more experience.
With six months to spare between qualifying as a doctor and starting my first job, I got in touch with a research group in Southeast Asia and went to work in Cambodia and Thailand to study drug resistance in malaria. I found myself with a great group of people and an exciting area for research and went back twice more, working with the same team in Thailand, India, and Bangladesh. For the past two years, I have spent half of my time there, and half back in the UK, working in hospitals in London and Oxford.
One of the most interesting things about clinical medicine is that it is constantly unexpected: on a given morning, there is no way to tell what challenges lie ahead. Research often stands in contrast to this: you pick up the unfinished pieces of the puzzle you were working on the day before, and the reward comes maybe years later when a few of them finally fit together. Working in both fields keeps each one exciting. The clinical work reminds me of why the research is worth doing and raises new questions that might be interesting to study someday.
We lug a lot of very clever machines with us to the research sites in Bangladesh and India, but the expensive gadgets interest me much less than the potential for technology that can be delivered cheaply and reliably in remote and resource-limited settings around the world. A good example comes from recent years in the fight against malaria: in most parts of the world, diseases are now diagnosed from a chromatographic assay, which uses a few drops of blood on a cassette containing a strip of filter paper, along with the lines of a pregnancy test. Unlike the gold standard test, a blood film read by an expert using a microscope; there is no need for specialist training or delicate, expensive equipment. This testing can speed up clinical decision-making and allow malaria and other diseases to be treated at an earlier stage before they pose such a grave threat to health.
In October, I began working in London again, training in Infectious Disease Medicine and doing research with UCH and the London School of Tropical Medicine and Hygiene. I hope to learn more about research that assesses and improves clinical care directly; studies not just looking at how malaria affects the body, but aiming to understand how it is treated in villages and cities around the world, and how that treatment can be improved.
Model UN was fantastic. The weeks in the Hague still stand as some of the most intriguing, hardest, and most fun of my life. The same goes for the late nights spent working on the newspaper. The acting was always fun - Tim Sandifer '98 and I trying to out-ham each other in the mud pit during A Midsummer Night's Dream stand out - as does just flying a kite by the lake at lunchtime. In the classroom, being taught by people who felt passionate about their subjects was a gift: Mr. Khan, Mr. Page, Dr. Rollo, Mr. Tudhope were some of the best teachers I have ever had (including my tutors at Oxford and Cambridge). I am incredibly grateful to them and will never forget their classes.
The best thing about TASIS England was that I was never asked to choose between the sciences and the humanities, or between academics and extracurriculars. Life requires all four of these. Schools that sacrifice one for another end up advocating narrow-mindedness at precisely the time when they should be making their students into well-rounded men and women.
What do I wish I had known? That failure is nothing of which to be afraid. Doctors and scientist consistently fail - daily. Medical research is the art of building a boat, launching it, watching it sink at the mouth of the harbor, and building another one from the sodden, broken timbers in the hope that one day it will sail out over the horizon. We learn more from our failures than our successes because we assume too readily that our successes are deserved and not merely lucky. Those goals that are beyond our grasp drive us forward.
Medicine is a bureaucratic, terrifying, infuriating, exhausting, sticky, and worth every minute. There are precious few jobs in which you can meet and help such a diverse cohort of humanity. There are precious few jobs that will give you occasion to cry, laugh, and value life so often or so much.
This article first appeared in the TASIS England Today magazine, Winter 2014-2015 issue.