MUSC medical student Shannon McGue receives prestigious Fulbright-Fogarty award to conduct cervical cancer research in Malawi

After gaining clinical research experience abroad, Shannon McGue, a College of Medicine student, will delay her fourth year of medical school to participate in a Fulbright-Fogarty fellowship to conduct cervical cancer research in Malawi. 
1. Your background demonstrates a strong commitment and passion to global health. When did you first become interested in Global Health? 
My interest in global health is really inextricable from my interest in public health. I was lucky to have the chance to complete a Global and Public Health certificate in college. My classes in that program really inspired me, especially a medical anthropology course and a seminar class that was based mainly on student presentations. Systems, resources, and culture shape individual health. Those courses helped me decide that while I want to care for individuals as a doctor, I want to also have a role in shaping health systems, especially figuring out how to tailor interventions to specific contexts. 
2. What do you value most about your global health experience at MUSC? 
MUSC Center for Global Health has been key in my continued involvement in global health! When I started at MUSC, I wanted to find research mentors with whom I could be involved both during the year and over the summer between first and second year of medical school. I met with Kathleen Ellis, Executive Director for the Center for Global Health, and she was kind enough to talk with me about my experiences and interests. She connected me with Drs. Kathleen Cartmell and Suparna Qanungo in the College of Nursing. Under their supervision, I completed an independent project assessing barriers to cervical cancer prevention in Kolkata, India over one summer. They also let me contribute to the write-up for two other studies about barriers to health care, one focused on human papillomavirus (HPV) vaccination in South Carolina and the other on palliative care for cancer patients in India. I really value them as mentors. Working with them has been the highlight of my global health experiences here. 
3. You recently received a Fulbright-Fogarty fellowship to spend nine months in Malawi for a research project that also focuses on cervical cancer, a significant global health topic largely unaddressed in Sub-Saharan Africa, and disproportionally impacting HIV-infected women. Can you talk a little bit about the project?
I will be helping with a clinical trial on a new screen-and-treat algorithm for cervical cancer and also conducting my own qualitative study with women who participate in the clinical trial. The trial is using vaginal self-swab and rapid HPV PCR testing as a screening modality for cervical cancer. This is in place of the traditional Pap smear, which requires not only a trained provider to collect the sample but also a pathologist to interpret the sample. The hope is that self-swab and PCR testing will be more feasible to implement in low-resource settings like Malawi. Another benefit is that self-swab has generally been found to be more acceptable to women compared to Pap smear, since it is less invasive and more private. As part of my fellowship, I will be organizing interviews with a subset of the participants to understand their experience with the self-swab. 
4. You've decided to delay your fourth year of medical school in order to participate in the Fulbright-Fogarty fellowship. What made you decide to take advantage of this opportunity now? 
I think this will be a great opportunity to explore my interest in clinical research and to connect with role models in the field. I was interested in going to the Malawi site in part because many of the investigators and leaders are physicians. I hope working at an active global health research site like this will give me more insight into how physicians are involved with this kind of work while still practicing medicine. For example, my research mentor is an obstetrician-gynecologist in the US and also serves as the primary investigator for multiple studies in Malawi. She visits the Malawi site several times per year. I’m hoping to gain research skills that will open up opportunities for me during residency and as an early-career attending physician.
5. With your MUSC mentors, you worked on a study which assessed the barriers and facilitators to cervical cancer in India. What were some of the challenges you faced? 

One of the major challenges was coordinating IRB approval for the study! Most people who have worked in global health have run into this problem, because in any study, there are at least two institutions involved, the US institution and the local one. Add to that the complications of working in different time zones, needing to transfer fees internationally, and needing to have documents translated. It all can be a slow and arduous process. I think working on this helped develop my patience and persistence! Another challenge I had was constantly worrying that my presence in the interviews skewed what participants said. Cervical cancer is already a sensitive topic for many people, since talking about HPV requires talking about sexual activity. To be open about one’s beliefs in that context is hard and even more so in the presence of a foreigner, a total outsider. For the qualitative study I am planning in Malawi, a local researcher will conduct the interviews alone; this is necessary as many of the participants will not speak English. I don’t think it is ever possible to remove bias, though. To give you an example, the cervical cancer screening trial in Malawi will be associated with a large well-reputed international research institution, and it is very possible that participants will be biased towards offering positive answers because they have a favorable impression of the institution or because they want that institution to offer further cancer screenings.
6. How do you think your previous research experience in India has prepared you for the research project you will be doing in Malawi?  
I think the project in India taught me the importance of being an advocate for my projects. I also learned a lot about project design from working with Dr. Cartmell and Dr. Qanungo. Plus, the experience of living in Kolkata for two months makes me feel more prepared for spending essentially two semesters in Malawi. Kolkata is wildly different from the city I will be living in next year, but still I feel more confident having had that experience of arriving in a foreign country alone, adjusting to a very different work culture, and dealing with the logistics of visas, new SIM cards and foreign banks.

7. What are some of your career goals? 
Number one, I want to be a good clinician. I plan to apply for residency in internal medicine when I get back from Malawi. During residency training especially, I want to prioritize learning how to be a good diagnostician and a good communicator. Beyond clinical work, I want to be involved in clinical research and possibly teaching. I’m really interested in how to implement health interventions in different contexts in order to reduce health disparities.
8. How do you think the experiences you have gained working in global health will help build on your career in the medical field?
The skills I’ve learned through global health research are definitely applicable to the skills I will need as a clinician, including problem solving, taking ownership of projects, being a thoughtful communicator, and having patience with setbacks. My hope is to incorporate research and public health projects into my future career as a doctor. I’m not sure what that will look like exactly, including how much time I want to spend on clinical work versus other scholarly activities, and I bet it will change throughout my career. I looking forward to exploring my interests in research and global health work more this year.
9. Any thoughts, advice, or words or wisdom for current MUSC students who are interested in global health? 

For those with very little exposure to global health who want to have an experience in a low-resource country, I think there are a lot of benefits in going abroad through global health education programs. I would try to find an experience, however, that does not involve traveling with a large group of Americans. It is a lot less likely that you will have experiences outside of your “bubble” when you are in a large group.
 I also don’t think you need to go abroad to be engaged or stay engaged with global health, though! Taking classes, reading books, and contributing to research projects from your laptop can all be valuable for you. For me, having done coursework and some light research in global health topics before going abroad helped me understand my experiences abroad and put my observations in context.
 When you are working on research related to a specific country or planning a trip somewhere, I would advise you to read about the country. 

10. Tell me something interesting about yourself. 
I have done nine half marathons and one full marathon. I am not a super fast runner, but I love it!