For Dr. Monica Diaz, a GloCal fellow in Lima, Peru, what she does and doesn’t hear are among the strangest things about living through the COVID-19 pandemic.
Lima is known for “horrible traffic and a constant stream of honking car horns,” Dr. Diaz said. Now the streets are quiet and barren during the day and nearly silent starting at 6 p.m., when an enforced curfew begins.
“I live in one of the noisiest parts of Lima, and it’s very eerie hearing absolutely nothing at night. It feels surreal,” she said. “For the first time since my stay here, I hear birds chirping in the morning and cats howling at night.”
GloCal fellows work in and come from countries around the world. Fellows spend at least 11 months of the 12-month fellowship at the international site where they conduct their research. As COVID-19 rages, fellows are living through the choices the countries where their research projects are located have made to control the pandemic.
For many, that’s meant a halt to their research and left them considering unplanned alternatives to finishing their work. Others have found workarounds to continue their projects as the countries where they’re living are locked down.
As of April 19, Peru had 14,420 confirmed cases and 348 deaths, according to La Republica. The country began its COVID-19 response on March 15. The president declared a state of emergency and the country’s borders and schools were closed. People were ordered indoors except for essential services. These restrictions have been extended repeatedly, most recently until May 10. A 6 p.m. curfew was instituted in Lima and a 4 p.m. curfew in the countryside. A policy of gender-based days for people to be out of their homes was recently abandoned after it resulted in more crowded markets because women do most of the shopping in Peru.
Dr. Diaz is a post-doctoral fellow and neurologist at the University of California, San Diego. Her GloCal project is to study neurologic consequences of HIV, including dementia or neurocognitive impairment, as HIV-positive people age. Working within a clinic in the center of Lima funded by a non-governmental organization, she and her team are assessing how well these people’s memories are functioning and collecting other data to determine risk factors in Peru that may worsen someone’s memory or their ability to concentrate.
When the country was initially shut down, the only part of the clinic deemed essential was the pharmacy, leaving Dr. Diaz with no access to patients and essentially shutting down her research. Leaving on a military plane at the start of the lockdown was an option for Dr. Diaz, but she chose to stay.
“I think I made a good decision. I think things are calm here and I have some hope that it will get better with the quarantine measures that they have in place,” she said.
For now, she’s in her apartment catching up on work. She’s also starting to develop a new study with neurologists at a public Lima hospital to determine neurological symptoms among COVID-19 patients.
“I’m excited to be contributing to some coronavirus research in Peru while I’m still indoors in quarantine,” Dr. Diaz said.
Dr. Diaz must return to the United States in the fall for a new faculty position but feels the research could continue after she leaves.
“I have research assistants who have been working with me these past nine months the study has been going on. So even without me being physically present here, it could be that I can continue recruitment and continue the study with the research assistants taking the lead and doing the scheduling and the visits,” she said.
GloCal fellow Dr. Cathrine Tadyanemhandu is a physiotherapy lecturer in the Department of Rehabilitation at the University of Zimbabwe. Zimbabwe began a lockdown near the end of March. The country as of April 15 had just 23 cases and three deaths, according to Zimbabwe’s Ministry of Health and Child Care, but the low numbers may be partly due to lack of testing and testing delays.
According to Dr. Tadyanemhandu, the country’s lockdown restrictions require people to stay at home except for essential services. Markets were closed for part of the quarantine, then reopened with distancing measures. People can shop only within a three-kilometer radius of their homes, and shops are open from 9 a.m. to 3 p.m. Public transport has been eliminated except for government-operated transport, social gatherings of more than two people are banned, and funerals are allowed no more than 50 people. The lockdown, which was initially set for 21 days and was to expire April 19, was recently extended to May 3.
Dr. Tadyanemhandu’s project is to determine the prevalence of and risk factors for chronic lung disease in patients who have been treated for tuberculosis, and to treat these patients with an eight-week exercise, nutrition, and education program that has been successfully used in patients with other chronic lung diseases, including chronic obstructive pulmonary disease and asthma.
“We want to implement the same package in patients who have chronic lung disease due to post tuberculosis treatment to see if it’s feasible and acceptable in our setting and to see what changes actually result in these patients in terms of the long-term outcomes,” Dr. Tadyanemhandu said.
Dr. Tadyanemhandu’s project was delayed before Zimbabwe’s lockdown. The delivery of supplies she needs from South Africa has been repeatedly postponed. She had recruited patients at a primary health-care facility in the community but did not reach her desired sample size. Her project includes group therapy for eight to 10 people, which she has had to end due to the ban on group gatherings.
The lockdown “has resulted in a pause on the research activities that I can do,” she said. She’s spending her days at home on her laptop working on online courses. Her internet access is limited due to cost, and she’s unable to visit her office to use the internet there.
In Zimbabwe, as in much of the rest of the world, face masks can be hard to come by, and sometimes Dr. Tadyanemhandu visits shops without one. “Whenever you hear someone coughing or sneezing you really are not sure and you start having these fears,” she said.
The government is vigorously enforcing travel restrictions, she said. “There are roadblocks everywhere preventing unnecessary travel and people being arrested if found on the other side of the law,” she said.
If the quarantine continues after May 3 and she cannot get the supplies from South Africa, she will discuss with her mentors possible ways to move forward without the supplies, Dr. Tadyanemhandu said.
GloCal fellow Keenan Withers is a medical student at UC Los Angeles studying how frequent use of amphetamine-type stimulants, such as methamphetamine and ecstasy, affects whether HIV-negative Vietnamese men who have sex with men (MSM) correctly take medication to prevent HIV infection. This medication, which is known as pre-exposure prophylaxis, or PrEP, is much less effective if it isn’t taken daily.
In Vietnam, as in many other countries, use of amphetamine-type stimulants is widespread among MSM. In HIV-positive MSM, previous research has found that use of these stimulants may be associated with men not being able to take their HIV medication properly. For HIV-negative Vietnamese MSM who frequently use such stimulants, PrEP is a powerful tool to protect against HIV. But for these men to truly benefit, researchers need to understand the men’s perspectives and their behavior when using substances, which may affect how consistently they take PrEP, Withers said.
“We hope to use this information to improve PrEP services for this special subgroup of MSM who may be at high risk for HIV infection,” he said.
Vietnam mounted an early and strong response to COVID-19. In January, the country’s officials began testing and quarantining people and tracing their contacts. Vietnam quarantined part of the country in mid-February. The government set up quarantine camps and banned international and domestic flights. A national lock down began on April 1. People who violate the government’s regulations to prevent the spread of the virus, which include wearing a face mask, are fined. As of April 20, the country had just 268 cases and no deaths, according to the Vietnamese government newspaper.
Withers’ base for the fellowship is Hanoi, but his research has been in both Hanoi, which is in the north of Vietnam, and Ho Chi Minh City, also known as Saigon, in the south of the country. Withers is working with four community organizations that provide services to MSM.
Since the national lockdown began, he’s been working in his apartment in Ho Chi Minh City.
“Overall, I feel relatively safe here,” he said. “The Vietnamese government has done a really great job with a number of public health strategies, including contact tracing, containment, and testing, early on.”
Despite the lockdown, Withers has found a way to continue his GloCal project. He realized that many possible research participants use Facebook and other social media applications. With the help of the community organizations, he’s reached MSM through social media and used Zoom for screening and for interviews in Hanoi. He may eventually use the same approach for Ho Chi Minh City as well.
Although it wasn’t in his initial plan during his fellowship, the online approach is working, he said: it’s convenient and protects both the participants and the researchers by promoting social distancing.
“The population I am interviewing is a very discrete, hidden, and hard-to-reach population in medical research,” Withers said. “However, it is critically important to reach out in order to improve HIV preventative services like PrEP for them in Vietnam.”
Dr. Diaz, Dr. Tadyanemhandu, and Withers are joined in their challenges by many other GloCal fellows, said Kimberly Bale, deputy director of the GloCal Health Fellowship.
“We currently have 22 GloCal fellows conducting research in 8 countries across Latin America, Asia, and Africa, and have new fellows scheduled to begin projects in several additional countries later this year,” said Bale.
“Every day I am checking the Johns Hopkins coronavirus map and local news for updates on the situations in each of these countries, and maintaining close contact with our fellows regarding their conditions. I think they have all done an excellent job of adjusting their research and lives to these very unexpected and unprecedented circumstances,” Bale said.
“While we have ensured the health and safety of our fellows, I think the COVID-19 pandemic demonstrates the tremendous need to train the next generation of global health research leaders from the U.S. and around the world,” said Dr. Craig Cohen, director of the GloCal Health Fellowship.
“I remain truly humbled and inspired by the altruism, drive, and compassion our fellows have for advancing their research while also striving to improve the lives of the communities in which they work,” Cohen said.