Every summer a dozen or so Yale students go abroad to conduct original scientific research as part of the Downs International Health Student Travel Fellowship. They work on challenging health problems in unfamiliar settings and with limited outside support.
They return exhilarated.
“It is an ‘aha’ moment in their lives,” said Leonard Munstermann, chair of the Downs Fellowship Committee. “To a person, there is an enthusiasm derived from the excitement of living abroad and seeing the real world from the human health perspective and having the satisfaction of contributing to solutions for some of its problems. It’s a remarkable experience that is totally positive.”
As the Downs Fellowship marks its 50th anniversary this year, more than 400 Yale students have had these ‘aha’ moments thanks to Wilbur G. Downs, M.D., M.P.H., an accomplished physician/scientist and renowned globetrotter. He instilled in students the importance of getting out of the classroom and traveling the world to help combat public health problems. Downs was a professor of epidemiology and public health. He directed a malaria control program in Mexico, established a renowned virus research center in Trinidad and many other global health contributions. His legacy is the many students who have followed in his footsteps, undertaking health-related research worldwide.
The Downs International Health Student Travel Fellowship, established in 1966, was a forerunner of today’s global health movement at Yale and many other universities. It honors Downs, a man of insatiable curiosity who believed deeply in the value of global travel for a well-rounded medical education. In addition to his medical activities, Downs pursued a wide range of interests. He was a skilled fisherman and marksman, a photographer, stamp collector, guitarist and even a bookbinder.He was an inveterate entomologist—the many insects he collected and identified (both disease vectors and aquatic insects) are now housed at the Yale Peabody Museum’s Entomology Division and attest to his breadth of knowledge.
The Fellowship requires a minimum of 10 weeks fieldwork and supports Yale graduate and professional students. Each applicant must design projects to conduct original, medically related research in resource-poor countries with marginalized populations. Masters and Ph.D. students in the schools of public health, medicine, nursing, the physicians’ assistant program and the graduate school of arts and sciences are the most common recipients, although health-related proposals from other segments of the university have been funded. The fellowship provides airfare and ground transportation to and from host country, visa costs, pre-departure medical expenses, site-specific immunizations, evacuation insurance and a modest research supplement. Downs administrators urge students with previous international experience to select more unfamiliar countries to enhance the freshness and cultural value of their experience.
Students are expected to initiate and be personally responsible for the projects that they pursue. They are required to have both a faculty sponsor and an overseas sponsor. The choice of research topic and methodological detail are responsibilities that each applicant and his or her advisers organize together.
Munstermann, a senior research scientist at Yale School of Public Health and head curator of entomology at the Yale Peabody Museum of Natural History, noted that, in the past 20 years, the number of foreign students applying for Downs Fellowships has steadily increased. “Initially, the fellowship was designed to give U.S. students a chance to see other parts of the world,” he said. “Now, we often see foreign students who are interested in expanding their medical horizons via this opportunity.”
Student applications for a Downs Fellowship are evaluated on the basis of innovation, design, and analysis, as well as the novelty of the cultural milieu for the applicant. Prior to their departure, selected Downs Fellows complete a comprehensive pre-departure training that includes issues of personal safety, sexual harassment and research ethics.
After the overseas research has concluded, students share their research findings and experiences at the annual Wilbur G. Downs Fall Symposium and poster session. In the following year, most Fellows develop their research into a thesis or dissertation. Many projects have led to outstanding theses and peer-reviewed publications, as well as oral presentations and posters at national and international health conferences. Surveys have found that being a Downs Fellow has helped many students shape new perspectives on the responsibilities and capabilities has health professionals.
Soledad Colombe spent her fellowship time in Thailand in 2015 conducting a field epidemiology research project with the Ministry of Public Health. She carried out a cross-sectional study of Brucellosis and Q fever, two bacterial diseases that can be transmitted from livestock to farmer. She wanted to determine the seroprevalence at the herd level for livestock, identify risk factors associated with its level of seropositivity and evaluate management practices that pose risks for human infection. Colombe said she came to appreciate “what it is to work with a team in a culture completely different from mine and to be able to adapt to a new environment.”
Shaylen Foley, who spent her fellowship in Malaysia in 2015, investigated the reproductive health experiences of female sex workers in Kuala Lumpur, focusing on how the women prevent unwanted pregnancies and sexually transmitted illnesses. One obstacle she faced was the recruitment of female sex workers, since sex work is illegal in Malaysia. Consequently, sex workers were very wary of those outside their community. Foley came to rely on community outreach workers, who were former sex workers and many were transgender or gay. Working with this population, she said, enriched her learning experience and underscored the importance of community engagement.
Luis Maldonado, a 2014 Downs Fellow, did a mixed-method study on the protein intake and hookworm infection susceptibility in Ghanaian school-aged children. He said that his ability to think critically and build collaborations with communities improved significantly during the project. “I learned extensively about unexpected study-related problems that arose and choosing the best approach to address them,” he said. “I also learned about how to develop trust and strong partnerships with Ghanaian communities and how important community-based participatory research is for informing interventions and policy.”
Kaveh Khoshnood, associate professor at the School of Public Health and former chair and long-term member of the Downs Fellowship Committee, said the range of subjects Downs Fellows choose to study has varied widely. More recently, he has noticed a trend towards more policy research. Nonetheless, whatever topic students choose, it is invariably a “transforming experience. It is impactful,” Khoshnood said. “They learn to be global citizens.” Khoshnood said when students go into the field in a foreign country, they encounter situations they didn’t anticipate, such as trying to work when electricity and water aren’t available. “These are things you can’t teach; it comes from experience,” Khoshnood said.
The Fellows work has led to publication in some prestigious publications, including JAMA. “That’s unusual for student-led research,” Khoshnood said, and although the students have the help of a faculty mentor, it’s led by individuals who are willing to go “beyond their comfort zone, beyond Yale.”