India-Tufts; PI Christine Wanke, MD
Fellowship Site: India-Vellore
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The Christian Medical College (CMC), Vellore, India is currently ranked as one of the top medical schools in India. The institution was founded by an American missionary in 1900, and exists to serve the needs of the local community and to train medical and paramedical professionals in holistic and ethical medicine. The Christian Medical College Hospital (CMCH) at Vellore is a 2000-bed tertiary referral hospital and has a long established track record in basic, clinical and public health research.
The college is experienced in the organization and conduct of training activities. The college also has a number of facilities that are unique in India. The Epidemiology Resource Center, Clinical Epidemiology Network, and Department of Biostatistics in CMC provide excellent support for the performance and analysis of research studies. The well-equipped laboratories are staffed by well-trained personnel who are in turn supervised by faculty responsible for diagnostic tests, and also have individual research interests that are well-funded from national and international sources. The National External Quality Assurance programs for biochemistry and microbiology are run by the respective departments in Vellore, which also participate in the programs run by the World Health Organization (WHO) and the CDC. The Director of CMC is committed to providing administrative and organizational support for any initiative that will establish CMCH as a prime training center in India in the fields of HIV, opportunistic infections, nutrition and metabolism. The presence of established community networks and dedicated clinic services run by various departments in CMC will also provide a base for studies carried out by trainee researchers.
CMC has a strong track record of training medical professionals and of promoting both field and basic research. The inculcation of an attitude of inquiry, acquisition of knowledge of basic methods of research and the conduct of research at various levels of health care are a part of the culture of the institution. Longstanding ties between US hospitals and teaching institutions have provided a research climate of a higher caliber than usually found in developing countries, similar to that found in the United States. CMC is a recipient of more than 80 current externally funded basic and clinical research grants, generating an estimated $3.8 million in direct costs per year.
Tufts University School of Medicine has a long history of commitment to international infectious disease research and has collaborated with CMC in this area since the 1960’s. Currently, there is an agreement of cooperation between Tufts University and CMC to continue to develop collaborative programs. Of particular relevance to this application, is the ongoing training collaboration through the Global Infectious Disease Research (GIDR) program for which Dr. Gagandeep Kang at CMC is the Program Director (PD) and the Fogarty AIDS International Training Program (AITRP) at Brown and Tufts for which Dr. Kenneth Mayer is the Program Director and Dr. Christine Wanke is the Program Director of the Tufts Subcontract. In addition, the Department of Public Health and Family Medicine at Tufts has an agreement with CMC to send combined MD/MPH students who are concentrating in Global Health to CMC to conduct their Master’s thesis.
Research Opportunities:
- Transmission dynamics of Cryptosporidial infections in India, PI-Kang (2008-2012, RO1 A1075452, NIH)
- Probiotics for Infectious Diarrhea in Children in South India, Indian PI-Kang, G. US PI-Ward, H. (2008-2010, R03 HD 057736-01 NIH/Indian Council for Medical Research)
- Immune Response to Cryptosporidiosis in a Birth Cohort of Children in S. India, US PI-Ward, H. Indian co-I-Kang, G. (2008-2013, 1R01 AI 072222-01A2, NIH)
- Hospital based surveillance for rotavirus disease and strains in India, PI-Kang, G. (2006-20095/8-1(183)/Task-Force/2002-ECD-II, Indian Council for Medical Research, CDC Foundation/ PATH)
- Production and delivery of antibody fragments against gastrointestinal pathogens by lactobacilli Overall PI-Hammarstrom, Indian PI-Kang, G. (2008-2011, Health FP7.202162 European Commission)
- Caliciviral infections and disease in southern India. US PI-Estes, M. Indian Foreign Collaborator-Kang, G. (2007-2010, RO3TW007764, NIH)
- Pathogenesis and novel treatment of rotavirus diarrhoea. Swedish PI-Svensson, Indian PI-Kang, G. (2008-2011, 2007-3467-59221, Swedish International Development Agency)
- Epidemiology of hepatitis E infections in urban and rural southern India. Advanced Center for Liver Diseases. PI-Chandy, Co-I-Kang, G. (2006-2011, 5/8/7/5/2000-ECD-I, Indian Council for Medical Research)
- Characterization of human caliciviruses from India and expression of recombinant capsid proteins in insect cells using the baculovirus system. PI-Kang, G. (2007-2010, SR/SO/HS-104/2005, Department of Science and Technology)
- Fut2 and ABO gene polymorphisms in determination of susceptibility to noroviral infections. PI-Kang, G. (2008-2011, 18/11/23/2006-ECD-I, Indian Council of Medical Research)
CMC has been a site for the Fogarty International Clinical Research Scholars Program, linked to the Brown-Tufts AITRP. We have hosted 5 U.S. and 5 Indian trainees so far. Their research projects were on antenatal HIV screening and prevention of transmission, point of use water disinfection in a rural community (Jacqueline Firth, Tulane University), nutritional supplementation in tuberculosis and TB-HIV coinfected individuals undergoing directly observed short course chemotherapy, establishing a PCR for dengue (Mark Franciosa, Boston University), costing of all cause and rotaviral gastroenteritis at different health care facilities (Andrea Finkelman, Tufts University), outcomes in HIV positive and HIV negative children of HIV positive mothers (Karen Ast, State University of New York, Downstate), cryptosporidial infections in calves and children in cattle owning households in rural areas (Elliott Garber, Tufts Cummings School of Veterinary Medicine), knowledge and practices regarding sanitation and water safety, immune responses to gp15 in children with cryptosporidiosis (Kalyan Banda, CMC), geographic information systems in mapping water contamination in a village (Srila Gopal, CMC), giardial infections and cognitive development in children in an urban slum (Kirthi Satyakumar, CMC), Geographic Information Systems and water safety in rural and urban Vellore, understanding participation in research a community based cohort study (Rajiv Sarkar, CMC) and nutritional supplementation and effect on intestinal function and nutritional status in malnourished children in balwadis in rural Kaniyambadi (Azara Singh, CMC). Among these, five students have presented their work at international meeting and three at national meetings. Three papers have been published, two accepted for publication, one is under revision and four are being prepared for submission.
The success of collaborative training between CMC and Tufts is also supported by the successful completion of Tufts MPH degrees by two CMC faculty in the Community Health Community, supported by the Fogarty AITRP; one of these faculty members has just been awarded a Global Research International Program (GRIP) award by the Fogarty International Center.
All trainee research projects have to be cleared by the Institutional Review Board at CMC, and have to be conducted under the supervision of a member of the CMC faculty.
One unique activity at CMC in which FICRS scholars have been encouraged to participate in the past is the Community Orientation Program. CMC medical students participate on site in a three week program in September, where for the first 3 days they are provided training in social and cultural issues in rural southern India, the structure of CMC’s primary and secondary health care system and the collection of basic demographic and health related information.
Housing/Meals/Transportation:
The India program has a two-bedroom furnished apartment about 500 m from the CMC Campus which is reserved for the use of FICRS Scholars. If there is only one Scholar in a year, we offer the second place to another U.S. student, since we usually have 5-6 students at any time who are in CMC for longer periods of time. It is equipped with a refrigerator, microwave, television, washing machine and air conditioners in each bedroom. This is on a quiet road, mainly housing retired CMC faculty and students in graduate programs. The bus stop is on the main road about 100 m away, and buses are available every 10 minutes. The College Campus runs a free bus service to the Hospital 7 km away.
The apartment rental will increase this year to Rs. 6,000/- ($150) per month which can be shared between the two occupants. With electricity, telephone and water charges and boarding expenses, estimated monthly costs will be between $400 and $500. This does not include weekend travel, entertainment etc.
Health Issues:
The FICRS Scholars usually have health insurance, but it has not been used so far. CMC is a tertiary care facility which can handle most medical conditions and emergencies and provides a level of service that is not available in many countries. All trainees are covered by the Staff Student Health Services. If, for any reason, a medical evacuation is required, the international airport at Chennai is two hours away and a 24 hour ambulance service is available.
See the U.S. Centers for Disease Control Web site and The Yellow Book: Health Information for International Travel.
The NIH/FICRS program mandates that all Scholars see a physician prior to their assignment abroad (hepatitis A and B).
Safety Issues:
South India is a safe place, where men and women can be comfortable with all kinds of transport and moving around at any hour. Shorts and casual dress are acceptable in non-professional settings, but it is best to avoid very brief or transparent clothing. In addition, ready access to international communication is consistently available by telephone and email. See the U.S. State Department Web site for information.
Language Requirements Other than English:
A Tamil tutor can be arranged, if required. However, this is a difficult language and not the only one required, because patients at CMC speak many different languages. We generally advise students not to take formal classes, but assign them study staff who can act as translators whenever required. With the wide availability of cell phones, a native language speaker can usually be accessed quickly for translation. The extent to which the Scholar is likely to need language support depends on their project and we ensure that arrangements are made at the outset to facilitate the Scholar’s research.
What is it like to live in India?
Christian Medical College in Vellore has a large campus, with visiting students from all over India as well as international students. The faculty are very attentive to visiting students' needs and provide a comfortable living environment in the midst of the academic medical center in a fairly traditional small city (250,000 population) in South India.
