Essay

Award Allows Medical Student to Pursue Passion for Combatting Global Health Inequity

Global Student Spotlight: Brady Sack

Brady Sack stands in front of the ocean.

rady Sack is a second-year medical student and was the 2024 Center for Global Health Equity (CGHE) Ram Family Foundation scholar. The Ram Family Center for Global Health Scholar Award was established to honor Dr. Bellamane M. Ram and Dr. Anjan Kumari Ram who practiced medicine in India and the United States. The award supports interdisciplinary work in communities in Southern India and is open to students from all schools across Grounds. In Summer 2024, as part of his award, Sack travelled to Pondicherry (Puducherry), in Southern India, for seven weeks where he worked with CGHE Director Dr. Scott Heysell, as well as Dr. Pranay Sinha. Dr. Sinha is an assistant professor at Boston University and was the inaugural Ram Scholar when he was a student at UVA. Sack spoke with UVA Global about his research in Pondicherry, his unusual path to studying medicine, and the ways he grapples with global health inequities.

Tell us about the project you worked on in Pondicherry.

Sack: My main project looked at ventilation in rural and urban homes as a risk variable in the transmission of tuberculosis. Our hypothesis was that because of the warming climate in Pondicherry, people have started to spend more time inside and that this may assist the spread of tuberculosis. The majority of tuberculosis cases are asymptomatic or, even if they do present, those who are affected may not have access to medical care. To test our hypothesis, we placed CO2 canisters in people’s homes and slowly released the gas to check how quickly it dispersed. This reflected how quickly the tuberculosis bacteria could disperse in the same setting. We had the opportunity to test in a variety of rural and urban living situations across socioeconomic classes. While there are a few different variables, generally we found that the difference between having windows open or closed made a much bigger difference than having air conditioning on or off. This was a pilot study and our results were not definitive, but we were able to submit them for publication and they are currently under review at an important medical journal.

I also worked on a second project in the tuberculosis office at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIMPER), a medical school in Pondicherry. This project was jointly funded by India’s national tuberculosis program, the World Health Organization, and the National Institutes for Health. This project, TB LEOPARD, looked at the co-incidence of tuberculosis infection and parasitic infections. We wanted to know whether there is a high enough prevalence of intestinal parasitic infections among patients with tuberculosis disease of the lungs such that tuberculosis patients should be reflexively treated for these parasitic infections because they could be causing poor recovery from tuberculosis. My role was primarily in data analysis. We found a 40% prevalence of parasites in tuberculosis patients (about a 30% difference with respect to the rest of the population). This could have to do with exposure, as tuberculosis primarily affects people at lower incomes who may have dirt floors in their homes, which allow parasites to enter through the dirt.

Sack writes down something shown to him by woman, man smiles in foreground.

Madolyn Dauphinais, research coordinator at Boston Medical Center in the Section of Infectious Diseases, Sack, and Dr. Chinnakali Palanivel, professor at JIPMER in the Department of Preventive and Social Medicine.

How did you become interested in this research?

Sack: In the most direct sense, Dr. Heysell got me involved in this research, but my interest in infectious diseases and global health equity has a much longer history. My grandfather was an infectious disease doctor and researcher at Johns Hopkins University. He worked in India, as well as Peru and other places, researching cholera. My great uncle was also an infectious diseases doctor. When I was growing up, I absorbed their stories. My grandfather was very passionate about his work, to the point that he never retired and continued working up until he passed away in 2016. Seeing how both my grandfather and my grand uncle felt that this research was worth dedicating their lives to helped to highlight to me how meaningful it was.

With that said, I didn’t originally intend to pursue medicine. When I was an undergraduate, I was first interested in aerospace engineering, robotics, and software development. Then, in my junior year of college, I got really sick. I had a lot of gastrointestinal symptoms, including bleeding, and I spent a lot of time in the hospital. While my experience was hard, I had a lot of support, financially and emotionally. I couldn’t help comparing my experiences to those of a friend of mine who was suffering from a brain tumor. Unlike me, my friend did not have the same support or access to resources. This brought up feelings in me about healthcare inequity, which is particularly prevalent when dealing with infectious diseases. Tuberculosis, for example, was recently the leading infectious disease killer globally, with a total of 8.2 million people newly diagnosed in 2023. Tuberculosis disproportionately affects people in low- and middle-income countries. It is curable, but globally we have decided it’s not worth curing because it costs too much money and labor. I want to work against this inequity in infectious disease treatment and research.

Seeing how both my grandfather and my grand uncle felt that this research was worth dedicating their lives to helped to highlight to me how meaningful it was.

How did your time in Pondicherry affect you, both personally and in terms of your professional goals?

Sack: In some ways, I felt prepared for the differences between India and the U.S. In 2021, I spent a gap semester working with the Beyond Borders NGO in Peru. Beyond Borders focuses on education and agriculture. A lot of people in the area where I was working were leaving. Beyond Borders tried to provide job opportunities to give them reasons to stay and to have a better life where they are. Looking at India, Peru, and the U.S., there is a lot of inequity in each country, even though the U.S. is much wealthier. The striking difference between the U.S. and the other two is the living conditions or the quality of the homes people live in.

Sack with Abdul Basith.

I would add though that in general cultural immersion is really challenging! You’re put in a situation where you don’t have access to the things that you associate with comfort, even linguistic comfort. This challenges you to see different ways of living that are equally rich, but distinct. In Pondicherry, in particular, many of the patients I saw speak Tamil primarily and less English. I am so used to communicating with full range of expression, but with Tamil I wasn’t able to. I had all these ideas that I thought were good and wanted to share and I couldn’t. It was humbling. It gave me an appreciation for the immigration experience and how difficult it is to communicate and learn a new language. Those are very real barriers. One highlight for me though was working with Abdul Basith, a resident doctor at JIMPER, on the tuberculosis ventilation project. He was a touch point for my cultural immersion. In addition to his guidance with the research, he also helped me socially and we became friends.

What do you see as the future directions for your work?

Sack: Dr. Sinha is working with an India-based researcher, Professor Sandip Mandal, using Google software to track people’s movements and see where they’re spending time. They intend to integrate this information into a model about heat waves inspiring people to stay inside more in Pondicherry. I would like to keep doing analysis on this project.

In general, I want to keep working on the questions of health inequity, whether that’s in the U.S. or another country.