Diaspora Stories: Combating Infectious Disease in the Philippines

A couple of months ago, we had the privilege of learning about Dr. Juan Puyana's work to reduce trauma in Colombia by collaborating with trauma surgeons there. 

We're going to continue this series of interviewing active diaspora, and below Dr. Bernard Macantagay (Assistant Professor of Medicine at the University of Pittsburgh) shares a similar tale of how he was able to establish academic partnership with the University of the Phillippines to help strengthen research capacity in infectious disease. We're accepting submissions! If you know of any other active diaspora that we can profile (including yourself), by all means email us at diasporahealthnetwork@gmail.com. 

On how it all started.

I was born and raised in the Philippines and completed medical school in the Philippines. I always knew I wanted to get into ID, even before medical school. In medical school during my free electives I did parasitology, and after medical school I didn’t go straight to residency. I actually did field parasitology with Dr. Belizario, who is a professor there of parasitology, and who eventually became deputy director and director of the NIH of the Philippines.

He was an amazing mentor, and I did a lot of work with him going to the field, doing deworming kids and looking at poop to see if they’re infected or not. Then after one and half years or decided that I’ll go to residency so applied here in the US. When I got here, I fell in love with HIV. My mentor at that time, Gail Skowron, is an HIV immunologist and has an HIV clinic. She recommended that I apply to Pitt. This was my first interview and I fell in love with the program and so I ranked it first and was lucky enough that they ranked me! I did two years of general ID and two years of HIV/AIDS fellowship here.

I think the important thing is to get people high up in both institutions.
— On forging academic partnerships

When I was a second year fellow, I found out that Dr. Bellazario frequently travels to the US as a consultant for the WHO in the Philippines and the Western Pacific Region. [When] he said he was coming to the US, I asked, “Why don’t you come to Pittsburgh and talk about tropical medicine? We don’t get to see a lot of tropical medicine and I think the fellows will have a great time.” And he came to Pitt and said, “I don’t want to just visit and give talks; there should be something that comes out of this.” We discussed all this in 2007, [and] in 2008 [Associate Vice Chancellor for Academic Affairs] Maggie McDonald and [Associate Dean for Global Health] Peter Veldkamp went to the Philippines and the 1st MOU was signed between Pitt and the University of the Philippines. And since 2008, we’ve had medical students and pharmacy students and GSPH students going there to do research. We’ve also had medicine residents and an ID fellow going there.

Edsel Salvaña, my classmate in medical school who trained at Case Western and is now back in the Philippines, comes to Pitt and teaches Tropical Medicine here, because we made him Adjunct Faculty. Pitt and the University of the Philippines had had several publications together. Moving forward we want to have a lot more ID fellows from the Philippines coming here to do part of their training.

The thing is, just right about this time the cases of HIV in the Philippines just started skyrocketing. In the 80-2000’s the cases of HIV in the Philippines was very low and then it was growing--exponentially. Why? People are trying to study all these things. Initially it started with call centers but now the number of cases that we’re seeing monthly is so high. Pitt may be able to help try to control that by helping to train more people from there to do epidemiology research, and now that I have my own lab, to train them with some immunology research.

We currently have three students who are going to the Philippines this year. And we are going to try to get some more medical students from there to come (to Pittsburgh). Actually one of the Edsel’s research assistants is a PhD candidate here now. Our plan is to have more trainees in research here to give them additional training in immunology and virology so that they can apply this knowledge in the Philippines.

What are the specific projects that have come out?

So a lot of these projects have been parasitology projects. The worm burden in public schools right outside Manila is about 80%, and it affects the children’s school performance. We have our medical students trying to go out into the community and figure out the factors associated with this so that we can do interventions. The year before, they did a study on pregnant women. We’re trying to formalize more collaboration in HIV research. And hopefully (our PhD student) could go back to bring some of the technology here over there. We’re hoping to get more people to train in epidemiology here (since Pitt is part of the Multicenter AIDS Cohort Study with Northwestern, Hopkins, and UCLA) so that they learn from our experience with the MACS and go back to do something similar over there.

How do you overcome the kinks?

Remember the people we’re collaborating with there are very, very busy. They carry a lot of responsibilities. Although there is research, the infrastructure is not as developed as what we have here. The doctors who are interested in research will also have to earn a living by doing clinical work. They work in the Philippines General Hospital, which is a public hospital, and they have to have their own private practice. They have to juggle all these different things to make a living and to push research forward. Any time Peter [Veldkamp] and I are there or when they’re here, we maximize on those times to discuss projects and to get the process started. Because sometimes, when you send an email, it’s just really hard to get follow-through with all the work we’re doing here and they’re doing there.

I think the important thing is to get people high up in both institutions. Because if it weren’t for someone like Dr. Belizario and Peter (Veldkamp) and Maggie McDonald, I don’t think things would go where they’re going now, because (Edsel and I) were just ID fellows when we started the collaboration. Now, we just continue to renew our MOU.

Any other dreams you have?

To get a grant where we have a PI both here and there, and to be able to start a cohort and do treatment and prevention studies in the Philippines. Also, to get more people from the Philippines to do additional training here in HIV research.

On his medical education in the Philippines and his motivations for continuing this work.

Since the government paid for a great majority of our tuition in medical school, I believe that it’s our duty to be able to give back…and that’s one of the things I always keep in the back of my head as to why I keep on doing this because [the government] really helped me out. Also my dad’s a doctor and he was the Chairman of our barangay [village; several villages make up the town/city], and because of that, my sister and I were considered barangay scholars, so we paid even less. I think in the first two years of medical school I was paying about $3 a semester. And it’s the premier medical school in the Philippines.  You don’t forget something like that, and so this collaboration has to continue to go on.