My experience as a PhD student – Interview with Linda Wammes, MD, PhD

L.J. (LINDA) WAMMES
Born 1980, Woerden, the Netherlands

2005: MSc in Biomedical Sciences (Leiden University)
2007: MD (Leiden University)
2013: PhD: Immune Regulation during Parasitic Infections: from bench to field. (Collaborative project between the Leiden Parasite Immunology Group, Leiden University, the Netherlands and the Helminth Group, University of Indonesia, Jakarta, Indonesia)
2011 – present: Chair Uniting Streams (www.unitingstreams.com)
2013 – present: Resident in Clinical Microbiology, Erasmus Medical Center, Rotterdam

What is the subject of your PhD thesis?
Together with two other Indonesian PhD students, I was involved in a research project about immunoepidemiology of helminth and malaria infections. Among other studies, we performed a double blind, placebo-controlled, household-randomized trial in two villages on the island of Flores, Indonesia.

What are the main conclusions of your study?
We have shown that regulatory T cells (Tregs) were involved in immune suppression during helminth and malaria infections in humans. These Tregs are able to suppress immunologic reactions to other infections and vaccinations, like the BCG vaccine. With our trial we showed that eradication of helminths led to an increase of immune reactions in human hosts, together with increased prevalence of allergy (measured by skin prick tests). This could mean that deworming could lead to more inflammatory diseases in these populations.

How did you become interested in doing research in the field of tropical medicine?
My first experience with research in the tropics was during my study Biomedical Sciences, when I participated in a study on perinatal mortality in Kigoma, Tanzania. I have always had a fascination for the clinical and biological aspects of infectious diseases and the power to answer relevant questions out of daily practice through science. This PhD project was the perfect opportunity for me to combine all these interests.

What were your first experiences in the field?
I knew from my experiences in Tanzania that the first weeks would be very intense and difficult. Though I did a short language course, I could not communicate fully with the local people. After one month of preparation in Jakarta, we moved to a small village on the Island of Flores. I was happy that my two Indonesian PhD colleagues accompanied me, because the locals did not speak any English and there were hardly any resources, nor internet. We built up our lab from scratch, but also had to collect the faeces samples in the two villages by motorbike.

In the beginning it took a lot of effort to explain our work to the locals. But after a while we got used to the situation and with some more support from the research team in Jakarta, we got over our frustrations and could look back on a great experience.

What were your biggest challenges?
Language and culture barriers were the biggest initial complicating factors. Later I also experienced ethical dilemmas, like when we gave half of these very friendly and co-operative people placebo pills. I am very grateful to the local people. Without them we would not have been able to investigate this very important and relevant subject.

What are the positive aspects of doing research in tropical settings?
First and foremost to work with an international team in a totally different environment and culture. I really enjoyed it, but also learned a lot personally and professionally. After the initial frustrations I really learned to be more patient, flexible and inventive. I could never have gained these experiences in another setting.

What is the added value of doing research in the tropics?
It is a unique possibility to set up and perform basic and relevant research in resource-poor settings. It will widen your vision on the world and will teach you to put things in perspective. Doing research could also be an interesting option for doctors who are more interested in working abroad in a non-clinical setting.

Research will contribute to capacity building among local health workers and the results can be used worldwide. For example, the results of our study led to recent trials in which is investigated if people with asthma or allergies could benefit from helminth infections.

Is there a future for PhD students in tropical medicine and international health?
At this moment most research is still performed in places where the global burden of disease is the lowest. There is, however, a great need for capacity building in low-resource settings. Both foreign and local research will benefit from doing research in low-income countries.

To promote this message I became chairman of Uniting Streams, a workgroup and platform for field research in International Medicine of the Netherlands Society for Tropical Medicine and International Health. Through providing information and sharing experiences from the field we try to make people more enthusiastic about research abroad.