“One thing that became clear to me while at Duke was how being a physician and researcher can be well-aligned with a focus in global health,” said Rifat Rahman, a 2016 alumnus and Benjamin N. Duke Scholar from Fayetteville, North Carolina. “The faculty at DGHI are great examples of that.”
Rahman, who majored in biology and minored in global health and chemistry, arrived at Duke knowing he wanted to pursue a medical degree but unsure of how his passion for global health could fit into his career. After four years of exploring global health through classes and research with DGHI faculty, he wanted a hands-on experience in global health research to further ground his pursuit of medicine and global health.
He found this opportunity in the Hart Fellows Program, a core program of the Hart Leadership Program in the Sanford School of Public Policy. The Hart Fellows Program offers recent Duke graduates ten-month fellowships with organizations abroad that are tackling complex social, political or humanitarian problems. Rahman is working with a community health initiative in Thailand.
Global Health FOCUS Struck a Chord
The Global Health FOCUS program introduced Rahman to global health at Duke. The FOCUS program, in which first-year students enroll in several small group seminar classes around a core theme, enables students to dive deep into a topic and build relationships with professors.
“Being able to regularly meet with the outstanding DGHI faculty was an unparalleled opportunity,” said Rahman.
Rahman credits this program with many of the close relationships he formed with DGHI faculty, including one with DGHI affiliate Catherine Admay. Having supportive professors that have advocated for him has allowed Rahman to further explore how global health and medicine can intertwine.
“Dr. Admay always made time to talk,” Rahman said. “She introduced me to the idea that physicians have a responsibility to serve as ‘natural attorneys for the poor.’ Social issues, from poverty to discrimination, can silently undermine health and should be should be a top priority in health conversations, and doctors have to lead those conversations.”
Malaria Prevention Was an Early Passion for Rahman
While in high school, Rahman started a club to support the nonprofit “Nothing But Nets,” an organization that distributes bed nets internationally to prevent malaria. He recalls stimulating conversations with DGHI associate professor Sherryl Broverman on bed nets in her “Global Diseases” FOCUS class freshman year.
“Within my first weeks at Duke, I was confronted with a number of challenges with the use of bed nets—a tool that for a long time, I had regarded as a ‘silver bullet’ against malaria,” said Rahman. “These conversations prompted me to think more broadly about how ideas and interventions that come out of the research lab can be vastly different in practice.”
During his freshman year, Rahman began working with DGHI professor and deputy director Randall Kramer on one of the first studies evaluating the use of larviciding for malaria control in rural sub-Saharan Africa. The study was published in Tropical Medicine and International Health last fall.
“Dr. Kramer let me take a leadership role in designing the study, analyzing the data and preparing the manuscript,” Rahman said. The research team helped demonstrate that in rural Tanzania, larviciding had similar implementation costs to bed nets.
“As more countries actively move from malaria control to local elimination, it’s important to think about new tools that can be used jointly with bed nets to further reduce malaria transmission,” said Rahman. “We’re hoping that larviciding may have a role, but we have to demonstrate this with evidence.”
Hart Fellows Program Brings Rahman to Thailand
Upon graduating, Rahman was accepted to the Hart Fellows Program. Now halfway through his fellowship, he’s working with the Raks Thai Foundation in Bangkok, Thailand.
A year ago, the Thai government established a fund for key populations at high risk of HIV, including men who have sex with men, transgender people, sex workers and people who inject drugs. The intent was for community organizations to use the fund to help these vulnerable populations gain easier access to HIV prevention services and testing.
But over its first year, the fund faced many challenges in implementation. While community organizations were well-positioned to link these marginalized and hard-to-reach populations to health services, they faced a number of technical challenges in accessing the funds. In the end, the number of key population clients who received services was far below the set targets.
As the fund enters its second year of implementation, Rahman is working with colleagues at Raks Thai on the Local Capacity Initiative, a regional project operating in Thailand, Vietnam and Laos, to support government efforts to redesign the fund to be more accessible to community organizations.
“It’s about getting the government and community organizations to talk to each other and recognize that they each have something valuable to contribute,” said Rahman. “Mobilizing community organizations to participate in this fund will improve the fund’s performance at the national level, making a strong argument for the government to continue investing in it. We’re also setting an important precedent for how governments and community organizations can work together in addressing health challenges.”
In addition to placing fellows in humanitarian organizations, the Hart Fellows Program also provides structured opportunities for fellows to reflect on and make sense of their experiences. “Internalizing what I’ve learned has been integral for me, and I hope the habit sticks,” said Rahman.
Rahman Is Applying Lessons He Learned from DGHI
As Rahman looks back on his time in Thailand so far, he’s reminded of one of the lessons he learned in DGHI associate professor David Boyd’s Global Health 101 course: the importance of making sure his work builds capacity within local people and health systems.
“It’s really easy for a gap to form between policymakers and the communities affected by those policies,” said Rahman. Through the Local Capacity Initiative, Rahman and his colleagues at Raks Thai hope to bridge that gap.
“We work closely with community networks to think about how they can work at the grassroots level to identify barriers in accessing HIV and health services, and then how they can engage policymakers in collaborative dialogue about how those obstacles can be resolved,” said Rahman. By applying the concepts he learned at DGHI, Rahman has been able to experience how system strengthening research takes shape in the real world.
“The only way forward is through the empowerment of local people. Patients and communities can be their own best advocates,” said Rahman. “They are there to stay, and they have a special understanding and appreciation of challenges that outside experts may not have.”
Rahman Looks Forward to a Multi-faceted Health Career
Rahman now foresees a Master of Public Health in his future along with medical school. He’s been particularly inspired by a physician at the Thai Red Cross whom he met through his fellowship.
“He has taken on a role as a physician that I really envy: he treats patients, he does medical research, and he’s a policy advocate who really gets into the weeds, building the connection between research breakthroughs and well-functioning policies.”
While Rahman came to Duke with an interest in combining medicine and research in a global health theme, he didn’t have a vision for how someone could engage effectively in all of those roles.
“Both DGHI and this fellowship have been transformative in helping me conceptualize a multi-faceted career in health,” he said. “Each has provided me with remarkable examples of people who have been able to balance several roles. They’ve shown me that the work doesn’t end at the patient bedside or the research table, but only when the patient’s health has improved.”
[DGHI affiliate Catherine Admay] introduced me to the idea that physicians have a responsibility to serve as "natural attorneys for the poor."Rifat Rahman '16, global health minor