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Downs fellowship brings student to a home she never knew

Yale Medicine Magazine, 2014 - Spring


A second-year student’s research in her parents’ home country leads to publication in a psychiatry journal.

In the summer of 2013, the same day Adesuwa Ighodaro stepped off the plane into the dry heat of Nigeria, a teachers’ strike began at the University College Hospital of Ibadan. Ighodaro had traveled to Ibadan, a city in southwestern Nigeria, on a Downs Fellowship to assess the attitudes of the university’s medical students and primary care physicians toward people with mental illness. But as the strike dragged on, her subject pool was shrinking.

This is exactly the type of challenge Wilbur G. Downs, M.D., M.P.H., the Yale virologist who gave the travel fellowship its start and its name, wanted young researchers to experience. “Downs was an eclectic character,” said Leonard Munstermann, Ph.D., senior research scientist in epidemiology and the current chair of the Downs Fellowship Committee. When Downs arrived at Yale in the 1960s, he paid for plane tickets—out of his own pocket—for one or two students a year to take their research abroad for a summer. He wanted to give students an opportunity to carry out rigorous scientific research and have a culturally enlightening experience. He sought out students who were independent and innovative; capable of dealing with the unpredictable but inevitable obstacles that occur during scientific research—especially research abroad.

The renowned fellowship was part of the reason Ighodaro had chosen to pursue her medical education at Yale. When she applied for the fellowship, the American-born Nigerian had never set foot in Africa, but she knew exactly which country she wanted to visit for her research project. Stigma toward people with mental illness in Nigeria is widespread. One study found that 96.5 percent of Nigerians surveyed believe people with mental illness to be both dangerous and violent. Those attitudes are not limited to the general public—many health professionals subscribe to the same stereotypes—but formal training in psychiatry could help to change negative attitudes. Ighodaro surveyed Nigerian medical personnel at three different levels of training; medical students who had yet to complete their psychiatry rotation, medical students who had already been through their psychiatry rotation, and graduate physicians.

She immediately ran into problems. Her subjects didn’t have reliable Internet access to complete an online survey, and the paper copies she sent ahead never arrived. “To this day I have no idea where they went,” she said, with a smile and a shrug. Thanks to the teachers’ strike, the classes where she had planned to hand out the paper surveys had been cancelled. Ighodaro took newly printed surveys door to door through the medical school dorms, passing out copies to any students still on campus, and then went back to collect them later. When she analyzed the data, Ighodaro found that both practicing physicians and medical students with psychiatric training were less likely to hold superstitious beliefs about witchcraft and mental illness and were more knowledgeable about the treatment and etiology of mental illness than medical students without psychiatry training. She showed that both education and clinical experience could result in more progressive attitudes among medical professionals. Her findings were published this year in the June issue of Academic Psychiatry.

“It’s unusual for a first-year medical student to complete a project that is published by the time she is a second-year student,” said Robert A. Rosenheck, M.D., professor of psychiatry and of public health, and Ighodaro’s advisor for the project.

Ighodaro is humble about her accomplishments. She credits Rosenheck, Victor Makanjuola, M.B.B.S., head of the department of psychiatry and her mentor at the University College Hospital, and even the dedication of the university’s medical students for contributing to the success of her project. “There were no classes, there was no reason for them to be there,” said Ighodaro. But many stayed on campus, continued to study, and even organized a march in favor of classes. “These [were] students fighting to study, to stay in school,” said Ighodaro, inspired and humbled by her Nigerian peers. Their passion for learning gave the young medical student a new appreciation for her own education here in the U.S.

Today the Downs Fellowship provides even greater support to Yale graduate and professional students carrying out health-related research in low- and middle-income countries than in Downs’ day. Thanks to an endowment started by the Downs family in the 1980s, fellows receive funding for transportation to and from their project sites, the cost of visas, any site-specific drugs or immunizations they may need, evacuation insurance and a small stipend. The medical school’s Office of Student Research provides funding for research expenses.

Ighodaro was one of 12 Downs Fellows selected from 24 applicants in 2013. “The Downs Fellowship has a fairly rigorous application process,” said Munstermann, and the competition stiffens every year. Applicants write the equivalent of an NIH grant—complete with background research, a sound and testable hypothesis, and the methods that will be used to test that hypothesis—plus a section on the extent of their cultural experiences. Then they present their research proposal to a committee of faculty and former Downs Fellows. For Ighodaro the fellowship was more than just a research opportunity and a new stamp in her passport; it was a homecoming.

Ighodaro’s interest in studying stigma stemmed from her own experiences as an outsider within the Nigerian-American community in Louisville, Ky., where she was born and raised. Her peers called her ‘Akata’—a derogatory term used to describe Nigerian-Americans unfamiliar with Nigerian culture. “A lot of my understanding of Nigeria was through second-hand stories,” she said. She had always been curious about her parents’ home country, but she had never been there herself and never learned their native languages of Yoruba and Edo. She always felt like she was trying, and failing, to prove herself as a Nigerian. The Downs Fellowship was more than just an opportunity to do real research in psychiatry; it was a chance for Ighodaro to demonstrate her appreciation for her culture, a chance to go back. “When I arrived, it was just a feeling of I’m here. I’m home,” she said.

Despite her personal connection to the country, Ighodaro still had much to learn. On her first day at the university, she failed to greet a stranger in the hallway, and was shocked to find him visibly upset. Proper greetings are an important sign of respect in Nigerian culture. “This is very important,” the stranger yelled at her. “Ekaaro. EH-KAR-RO,” he said, sounding out the Yoruba word for good morning. The lesson stuck. “It’s something I won’t ever forget,” said Ighodaro.

Traditionally, the Downs Fellowship has tried to provide a Peace Corps-like experience for its participants. It was meant to be a student’s first encounter with a new culture. “Many committee members [still] feel that it should be a mind-boggling, eye-opening experience,” said Munstermann. “Not only in terms of the scientific and health issues that working overseas provides, but also a personal growth experience, a chance to see what the world outside of the U.S. is like.”

But the world is shrinking. More minorities and foreign-born students are making up Yale’s ranks, and many are eager to use the education they receive here to give back to the developing countries where they (or their parents) were born. “Ade is part of that movement,” said Rosenheck. Still, the committee is wary of sending students home to visit their families. As the demographics change they are struggling to strike a balance between scientific rigor and cultural experience.

Ighodaro walks that line. She was familiar with Nigerian culture already, but she had never visited the country, she didn’t speak the language, and she had no family members in Ibadan. Still, there is something to be said for cultural familiarity, according to Ighodaro. “I think the Downs Fellowship prides itself on producing rigorous projects that can be published and perhaps going to your home country and already having connections to facilitate that process—because you can tell from my story there’s so many things that can go wrong—may even aid in enriching the research experience,” she said.

She came away from the experience with more than a first-author publication—she left Nigeria with a heightened appreciation for her family and their culture, a renewed respect for scientific research, and a sense of gratitude for the education and opportunities she’s had here in the United States. It was exactly the kind of mind-boggling, eye-opening experience Downs envisioned for Yale students.

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