James Nnamutete is a study coordinator at the Rakai Health Sciences program (RHSP) situated in Kalisizo, Uganda. His 17 years of expertise consists of his work with various clinical studies, including those related to human immunodeficiency virus (HIV) risk and transmission within the Ugandan community. This year, I had the privilege to visit RHSP in Uganda to help initiate a clinical study for my PhD project. James kindly participated in this interview for IMMpress Magazine, offering valuable insights into global collaborative research. Here’s a snapshot of a conversation between James and I, bridging the distance between Kalisizo and Toronto with our discussion.
Me: Hi James, thanks for taking the time to do this interview. Can you please give an overview of the RHSP organization?
James: RHSP is a collaborative biomedical research and service delivery organization in South Central Uganda dedicated to enhancing the quality of life of all community members of the district of Rakai through community-based research, services, and prevention strategies. Beyond research, it operates as a public clinic offering medical services, including HIV prevention, alongside additional services like prayer counseling. Through research opportunities, I have personally collaborated with institutes from Canada and the United States.
Me: From your perspective, does international research collaborations benefit RHSP and its community? How does RHSP do that?
James: There are a few benefits that I see from collaborative research. Each study enhances our international friendships, fosters a union between institutes, and continues to recognize RHSP’s efforts on a global scale. Through collaborations, findings are shared with the Rakai community [through community outreach programs like free soccer matches] to directly inform the health services that we provide. Importantly, international collaborators bring crucial funding to continue supporting active research from our side.
Internally, new projects allow staff to be trained with novel skillsets, thereby increasing and experience of our team. Likewise, new equipment purchased for studies remain in our research facility after the study ends, contributing to our resources and benefiting future projects and patient diagnosing. This increase in staff expertise and available equipment creates a positive feedback effect, enhancing our ability to secure more funds for research.
Me: Working with international collaborators must also bring some challenges along the way. Can you tell me about some of these challenges from your experience?
James: Participant-facing obstacles predominantly concern the language barrier found in international collaborations. Most participants are fluent in Luganda, with English as their second language, posing challenges during surveys conducted by foreign researchers. This can lead to participants being unable to fully express themselves in English. Cultural mistrust emerges when participants perceive foreign researchers as being able to abuse their information outside of Uganda. Nevertheless, RHSP’s image as a reputable research facility instills community trust. Conducting interviews with our Ugandan staff fosters greater confidence from participants, assuring that their personal information remains confidential and be used to directly benefit our community.
Working with international collaborators also introduces logistical challenges. Uganda is seven hours ahead of the collaborators that we commonly work with in Canada and the United States, and there isn’t much overlap during the day when both of us are working. This limits real time communication and feedback. While scheduling meetings helps, it can slow down work.
Systemic challenges persist in international collaborations. Funding is never guaranteed, and the loss of international funding impacts project sustainability and our global relationships. It is also easy to forget that there is a huge team behind each clinical study. For instance, there is an entire department that performs groundwork for the recruitment of participants for each of our studies. Their efforts are just as important as ours in the lab, but they are often overlooked in research.
Acknowledging the efforts of all individuals is essential for a comprehensive understanding of the collective contributions to research.
Me: Thank you so much! Okay, last question… Do you enjoy working here at RHSP?
James: Yes! Having spent a considerable amount of time, I still haven’t felt the need to seek other job opportunities. The collective success and achievements of RHSP and the community have created a shared journey that binds me to this organization. Without this unique connection, I might have considered exploring opportunities in other sections or departments.
Collaborating with RHSP provides unique insights into local challenges faced by communities globally in addressing the persistent global health challenge of HIV. International partnerships foster the exchange of insights on global health systems not readily apparent to other researchers, facilitating widespread knowledge dissemination through study publications. Global collaborations also promote ethical research practices and emphasizes the important of creating culturally sensitive research protocols. Since the questionnaires we use are initially prepared in English, tremendous teamwork and patience from RHSP are required to translate them into Luganda. Extensive international partnerships will not only support active research, but also reward participating institutions that produces research with global-scale social impact through funding and global reputation.
Despite spending an extended time at RHSP, this conversation has been incredibly enlightening, offering deeper insights into the benefits and challenges of working with international institutions. RHSP’s success with international partnerships is not only owed to the knowledge and expertise that each of its members brings, but also their positive and welcoming attitude when working with foreign members. Ugandans exude authenticity and hopefulness, rooted in their religious faith and strong connections with family and friends. I look forward to the possibility of visiting Uganda again and reconnecting with James and other friends and colleagues that I dearly miss.
*Conversations have been edited from the original interview for clarity and brevity.
Recent publications and studies based in RHSP 1–5:
- Prodger, J. L. et al. Chemokine Levels in the Penile Coronal Sulcus Correlate with HIV-1 Acquisition and Are Reduced by Male Circumcision in Rakai, Uganda. PLoS Pathog 12, e1006025 (2016).
- Kigozi, G. et al. Foreskin surface area is not associated with sub-preputial microbiome composition or penile cytokines. PLoS One 15, (2020).
- Liu, C. M. et al. The Effect of Antiretroviral Therapy Initiation on the Vaginal Microbiome in HIV-Infected Women. Open Forum Infect Dis 6, (2019).
- Prodger, J. L. et al. Penile bacteria associated with HIV seroconversion, inflammation, and immune cells. JCI Insight (2021) doi:10.1172/jci.
- Galiwango, R. M. et al. Immune milieu and microbiome of the distal urethra in Ugandan men: impact of penile circumcision and implications for HIV susceptibility. Microbiome 10, 7 (2022).