Omar Siddiqi, MD, one of 14 AAN Clinical Research Training Fellows selected this year, has always wanted to work on health issues in a global setting. His journey toward achieving that goal has been a circuitous one — beginning with an undergraduate semester abroad in Sydney, Australia (University of New South Wales); a post-graduate study year in South Africa, where he taught reading; medical school in Rochester, NY; a neurology rotation in India; and time spent doing research and providing medical care in the island villages of Madagascar. Currently, he works in the city of Lusaka, Zambia — his research site and the place he and his family call home.
After attending medical school at the University of Rochester in New York in 2004, Dr. Siddiqi completed his neurology residency at Beth Israel Deaconess in Boston. Last July, Dr. Siddiqi, captivated by his past international experiences, received a Fogarty International Clinical Research Fellowship to train in Zambia. The fellowship is a one-year mentored program set only in low- or middle-income countries, sponsored by the Fogarty International Center, the NIH, and managed by Vanderbilt University Institute for Global Health. His current work with the Fogarty Fellowship will complement his research for the AAN — a project that begins this July.
Dr. Siddiqi's proposal for the AAN Clinical Research Training Fellowship focuses on risk factors for the development of epilepsy in the HIV-affected population of Zambia. He is studying whether anticonvulsants contribute to drug-resistant forms of HIV. One of few neurologists practicing in sub-Saharan Africa, Dr. Siddiqi recently shared his influences and experiences in the challenging field of global health neurology with Neurology Today.
AAN Clinical Research Training Fellowships are funded by the AAN, the AAN Foundation, and the AAN Foundation Corporate Roundtable, and provide $55,000 per year for two years, plus $10,000 per year for tuition to support formal education in clinical research methodology at the fellow's institution or elsewhere.
CAN YOU TELL US ABOUT YOUR RESEARCH QUESTION?
I arrived in Zambia more than six months ago as part of the Fogarty Fellowship, which fit in nicely with my plan to move to sub-Saharan Africa once I finished training. A lot of choosing sub-Saharan Africa had to do with my prior experiences here — I had been in South Africa in 1997 as a Rotary International Ambassadorial Scholar in Cape Town and also volunteered in some of the clinics there, and I wanted to come back.
Along with my mentors, Igor Koralnik, MD, an HIV neurologist at Beth Israel Deaconess, and Gretchen Birbeck, MD, a neurologist from Michigan State who has long-standing research activities in Zambia, I decided to study first-onset seizures in the HIV population here [in Zambia] because there are no current guidelines on how to manage these patients.
In particular, the stakes are very high around the medical interactions seen between epilepsy drugs and antiretroviral drugs, where one can make the other less effective and vice versa. This study will help to determine risk factors for the development of epilepsy associated with HIV infection, as well as establish if the currently available antiepileptic drugs in sub-Saharan Africa promote resistant forms of HIV. It's a very important question, especially since seizures are among the most common neurologic problems among HIV+ patients. I received the AAN fellowship award in hopes of finding an answer.
WAS THERE A PARTICULAR PATIENT OR EXPERIENCE THAT INFLUENCED YOUR RESEARCH QUESTION?
It was collective experience that eventually got me here. When I was in South Africa, I attended the University of Cape Town and received a Diploma in African Studies. During that year, I volunteered for a student-run organization called Student Health and Welfare Companies Organization. As a part of this group, I worked with mobile medical clinics that would provide health care in various townships. I really, really fell in love with working with that patient population. I was fascinated by the issues of health care disparity, racial inequality, and also by the possibility of finding methods to improve health care delivery.
I still remember the feeling of sitting with the other volunteers and medical students from the University of Cape Town at the end of a long clinic afternoon when we were all exhausted. We always shared a wonderful kinship and satisfaction with our day's work. After that experience, I became focused on pursuing global health as a career – even before starting medical school. While in medical school, I was fortunate enough to have clinical experience in Madagascar and India as well.
I was also very interested in neuro-infectious diseases, particularly those affecting HIV+ patients, so my interests coupled with the tremendous need for neurological expertise in this part of the world made this region an ideal place to pursue my career.
WHAT CHALLENGES HAVE YOU FOUND IN YOUR WORK?
Working in Zambia, you do have to be prepared for anything happening — technological failures, inability to get tests, machines malfunctioning. There is also just a huge number of patients and only 800 doctors in the entire country — for 13 million people. There are only two practicing neurologists [here] — and I'm one of them.
HOW DID YOU DECIDE TO GO INTO NEUROLOGY SPECIFICALLY? WAS IT SOMETHING YOU WERE ALWAYS INTERESTED IN?
No, no… I tore my hair out about the decision — I really, really did. I went to the University of Rochester, which has a strong neurology program, and Ralph Jozefowicz, MD, who is an awesome health educator there… made neurology a ton of fun.
It was the one thing I really loved over everything else — but, I knew I had to do global health. So I thought maybe I could do internal medicine and infectious diseases. But nothing appealed to me as much as neurology did.
And then it was the rotation I did in India that helped me realize that neurological problems are not just problems of the developed world. In the developing world, people have neurological problems that are unique and untreated, and there's a huge deficit of knowledge around these issues.
DO YOU HAVE ADVICE FOR NEUROLOGISTS WHO WANT TO PURSUE GLOBAL HEALTH NEUROLOGY?
I think that it's partly my hope that in being here, along with the handful of other people who are doing global health neurology, the field starts to open up and becomes more easily accessible for those people who are interested in that career path. Although it paid off eventually, it wasn't easy. I'm always happy to discuss or give advice on the subject. There's a huge dearth of knowledge within the field that has not been adequately addressed. And it's a really viable path — and a fundable path, actually.
ON A MORE PERSONAL NOTE, COULD YOU TELL US ANYTHING ABOUT YOURSELF THAT YOUR COLLEAGUES MAY NOT KNOW?
My wife and I started dating in Cape Town 14 years ago. Way back, when we were young and foolish — not too foolish — we had this dream of coming back to spend time in Africa with our kids, and we actually ended up doing that. We live here with my four-year-old daughter and my two-year-old son, so we have, in a way, come full circle.