Tamara Giles-Vernick
Abstract: In this interview, leading Cameroonian microbiologist Dr. Sarah Eyangoh reflects on her contributions to the fields of tuberculosis and Buruli ulcer, on the nature of biomedical research in Africa, on being a woman and a scientist, and on the challenges facing the next generation of African scientific researchers.
Keywords: biomedical research, science, gender, Cameroon, tuberculosis, Buruli ulcer
DR. SARA EYANGOH IS A MICROBIOLOGIST specializing in two closely related bacteria—the tuberculosis bacillus (Mycobacterium tuberculosis) and Mycobacterium ulcerans. (M. ulcerans, the cause of Buruli ulcer, destroys skin and subcutaneous tissue and can lead to chronic, disfiguring ulcers and long-term disability; it occurs in some thirty-two countries worldwide.) Dr. Eyangoh, the longtime head of the Mycobacteriology Service at the Centre Pasteur du Cameroun (CPC), has since 2012 served as the center’s scientific director. In this capacity, she oversees all research and public-health activities, evaluates the institution’s scientific strengths, weaknesses, and opportunities, and sets new priorities and strategies for its current and future biomedical research. Dr. Eyangoh is an important figure in global health circles: she was recently nominated to the Scientific and Technical Advisory Committee to the Special Programme for Research and Training in Tropical Diseases, a program cosponsored by UNICEF, UNDP (United Nations Development Programme), and the World Health Organization.
The CPC is one of sub-Saharan Africa’s leading biomedical research institutions, with active, globally linked laboratories in virology, epidemiology, and microbiology, as well as other services. Created in 1959, the CPC is a Cameroonian public research institution, but also a member of the Institut Pasteur’s international network of thirty-two research institutes. The creation of this international network had its beginnings in the 1887 founding of the Institut Pasteur (Paris), a private biomedical research institution, and its subsequent expansion throughout the colonial and postcolonial world, with institutes in Africa, Asia, and Latin America, as well as in Europe and North America.
In a wide-ranging conversation in French one afternoon in her Yaoundé office, Dr. Eyangoh reflected on her contributions to studies of tuberculosis and Buruli ulcer, the nature of African biomedical research, what it means to be a woman scientist, and the challenges facing young African researchers. She insisted on the need to pursue biomedical research in Cameroon and Africa that leads to appropriate public health applications and spoke eloquently about the professional and gendered dimensions of biomedical research that transcend specific locations.
In the interests of full disclosure, I should add here the Institut Pasteur (IP) is my employer. But my knowledge of the complex historical and contemporary relations between the IP and its network institutions offered me insights that are not evident to those outside the institution. I have also worked with Dr. Eyangoh on a large Buruli ulcer study, and thus have witnessed her in action—her analytical incisiveness and extraordinary capacity to lead a (sometimes unruly) international scientific research team.
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You began your research on tuberculosis, characterizing different strains of tuberculosis found in Cameroon. Could you explain for readers the importance of tuberculosis in Cameroon and in Africa, and the significance of your own research on it?
In Cameroon and the rest of the world, tuberculosis is a huge problem. The prevalence of TB in Cameroon is high, about twenty thousand cases every year. At the CPC, we serve as the national reference laboratory for tuberculosis. That entails, for instance, the surveillance of multiresistant strains [bacterial strains resistant to available therapies] and the implementation of tools that allow us to detect resistant cases and to report them. In our lab, we have put into place all WHO-approved tools. We assist Cameroon’s national program by developing training, defining its strategies, supervising activities on the ground, and organizing everything that involves the laboratory.
In my doctoral work, I examined the profiles of resistant strains and collected data on multiresistance in Cameroon. We undertook this study in a pilot region of Cameroon because we couldn’t carry it out in the entire country. We were able to genetically characterize the strains circulating in Cameroon. At that time, there wasn’t a lot of work of this kind here. When I did the genotyping, I discovered that in Cameroon, about half of the circulating strains are quite diverse, but the rest is pretty homogeneous. This is what defines the tuberculosis family in Cameroon. Studies in Nigeria, Benin, and Côte d’Ivoire have shown that this family is dominant elsewhere as well. We didn’t really know why. The BCG vaccine [against tuberculosis; given at birth in Africa] played a role: Mycobacterium africanum was a very dominant strain during the 1970s, and there was a subsequent shift. Perhaps it was also the advent of HIV that allowed for an evolution, a change that affected the fitness of the bacteria that accounted for more and more cases.
We’re also interested in evaluating diagnostic tools that are better adapted to our context here in Cameroon. Working on TB requires strict biosafety measures because it’s highly transmissible, and not all laboratory and clinical structures can accommodate such measures. So I have been involved in developing tools that we can implement here.
I’m also interested in childhood TB, which can be exceptionally complex to diagnose. We don’t have good diagnostic tools for children. We’ve been participating in a study on tuberculosis in children co-infected with HIV. TB in children is very complicated, and when they are also infected with HIV, it’s terrible. We’re finishing up this study, but it was so interesting that we realized there was scope to develop another study in collaboration with the Pasteur network solely in Africa. We’ve just received funding to explore tuberculosis among children in three different countries: Cameroon, Côte d’Ivoire, and Madagascar.
I’ve heard you say that “Buruli ulcer is my baby.” Could you explain to those who know very little about this disease why it is important? And why BU is “your baby”?
I joked at a recent Buruli ulcer meeting that BU was my baby and tuberculosis was my husband. I carried this baby, I pushed it [to grow], and I almost abandoned my husband to tuberculosis, because the baby needed to grow up. I now believe that the baby has grown up and taken flight. So I’m returning to my husband, [because] tuberculosis remains a huge problem. It still needs my expertise. In the coming years, the research projects that I lead will focus on tuberculosis. But I’ll always support work on BU.
Buruli ulcer is important because it’s a disease that . . . how can I explain it? You could say that it is a horror. It’s true that when I was looking for funding, people would say, “So how many cases are there?” [About five to six thousand cases are reported worldwide each year.] They would insist, “But from a public-health standpoint, it isn’t important!” But it is a horror. You cannot close your eyes to this horror, even if it afflicts just one person. There aren’t many cases in Cameroon, and they have diminished recently. But cases are often concentrated in a single village, or a single region. So even for a small village or regional population, one hundred cases is enormous, even though for Cameroon as a whole and for the rest of the world these numbers don’t seem important. But it is a horror, and you cannot close your eyes to it.
It’s very important for research teams to continue this work because BU is truly a neglected disease. We don’t understand transmission, [and] we don’t really have a means of preventing it, because existing prevention strategies are so hard to implement. If we stopped doing this research, people whom the disease afflicts would be completely forgotten.
You’ve observed that you now supervise research, but you’re less involved in its day-to-day practice. This distancing from the laboratory seems to be the curse of successful scientists: the more you succeed, the further you are from actual research.
I think it’s a little sad, because we could give so much more to research if we could continue doing research. But at the same time, I realize you have to quit laboratory bench work, because this is how you invest in others. You use your experience to support other researchers, to evaluate them, to help them to start new projects. You discover that you’re now serving on commissions, on advisory committees, to define research objectives, to obtain research funding. So I don’t think we should call it a curse. To put it more positively, it is how a scientific career evolves. But you’re never prepared for this change.
It seems to me that this shift from the laboratory bench to advising and supervision is quite common among successful biomedical researchers around the world.
Exactly. But it’s hard to let go of the lab work. You have to, because otherwise you’ll exhaust yourself.
I found it striking that all the research you’ve conducted has an applied, public-health dimension—something that seems to be a common feature among African biomedical researchers. But elsewhere in the world, it isn’t hard to find biologists working on basic, fundamental questions. How did you make the decision to pursue biomedical research with public-health applications? Would you say that this feature characterizes biomedical sciences in Africa?
I don’t think that I made a conscious decision from the beginning. In reality, this is a dimension of biomedical research in Africa that must exist. Basic research is absolutely essential, but given our needs, our capacities in Africa, translational, operational research will yield the most fruit. When I talk to young students who want to do doctoral dissertations, I tell them, “Be really careful about your research question. I know basic research is essential, but it cannot exist by itself in our context. When you do only basic research, you risk evolving in a different way.” Sometimes adapting [to a local context] can be very difficult, because basic research requires very specific tools that don’t exist here. And even if they do exist, the maintenance, the costs, are prohibitive and the materials are difficult to get. But at a good research center like the CPC, you need some basic research to elevate the overall level of research. You also have to be able to communicate why it’s important, because otherwise, when you go to the Ministry of Health, they’ll say that you’re wasting money on research that doesn’t accomplish anything.
I want to ask a somewhat provocative question. At times, some observers have caricatured African science, saying that it lags globally because African laboratories lack resources, because scientists aren’t well trained, and because the most cutting-edge technologies aren’t available. How do you react to this characterization?
It’s too easy to caricature [African research]. You have to understand that doing research in Africa is already extremely complex. I’m always encountering people who ask, about one African researcher or another, “So what did he do this year? He only published one paper!” But what you accomplish in a single month [of lab work] in Paris will take you a year to do here. You might have the equipment, but it breaks down, and then you have to wait three months for repairs, even in the best institutions. So I would say to African researchers, “Hats off to those of you who dare, to those of you who don’t have the tools, to those of you who aren’t so well trained, to those of you who—despite everything that we lack—still dare to do this work.”
How did you decide to become a scientist?
I really think it was my husband, not me. I was always interested in the sciences, and it’s true that I always imagined myself in a lab coat, maybe a doctor. When I say that it was my husband, it was at a moment when I was struggling to get funding for my thesis in biochemistry at the University of Yaoundé I in Cameroon, and I told myself it wasn’t worth it. If I became a middle school or high school teacher, I could easily make a living. But he was always telling me, “You’re brilliant, you’ll get there! If you become a teacher, you’ll be bored.” So I hung in there, and thanks to my husband, I applied for and received a fellowship to do another masters-level training in tropical diseases with the Francophone University Association [AUF].
As part of this training, I decided to work on tuberculosis, although I don’t exactly remember why. I came to the CPC, and this was the first time that a woman worked in the TB lab here, manipulating salivary specimens. I must have made a good impression, because the lab chief at the time decided that he had found his successor—and it was me.
For this master’s degree in tropical diseases, I followed three months of lectures in Gabon [at the International Center for Medical Research in Franceville, or CIRMF], six months of training at the CPC, and then nine months at the University of Bordeaux [France] to finish up my training. I simultaneously pursued a DEA [Diploma of Advanced Studies], and saved up money from my fellowship to spend a month in a lab at the Pitié-Salpêtrière Hospital to do genetic characterization of apolipoprotein E [biochemical analysis of lipid-transport proteins]. This was the last part of my lab research for my PhD in biochemistry at the University of Yaoundé I. I returned here in 1999 and finished up my manuscript to graduate with my PhD. The following year, I received another fellowship—to do a doctoral thesis in microbiology to work on the molecular epidemiology of tuberculosis in Cameroon, at the Institut Pasteur [Paris] and Paris Diderot University. I defended my dissertation in 2003, but by then I was already heading a laboratory at the CPC.
Let me follow up with another slightly provocative question. From time to time I encounter colleagues insisting that the Institut Pasteur is nothing more than a neocolonial institution. How do you respond to those who insist that the Centre Pasteur du Cameroun, as part of the Pasteur network, isn’t a Cameroonian institution but a French neocolonial one?
This is part of my daily life! There are people who say, “It’s a French institution.” But it’s a public Cameroonian institution, and we do a lot of work with the [Cameroonian] Ministry of Public Health to assist in surveillance. In fact, we’ve never implemented a single research project that did not reflect the priorities of the Ministry of Public Health. Whatever work we do, we make certain that it is first and foremost part of Cameroon’s health strategy. We remind people daily that this is a public institution: it fits within the organizational chart of the Ministry of Public Health, and we work together to put public health into practice. But we are also members of the Institut Pasteur international network, because this membership opens us up to outside institutions and brings us funding. The Pasteur network offers undeniable support that allows us to improve the quality of our research.
As a woman, what do you bring to scientific research? Have you experienced being a woman as an advantage? A challenge? Does it figure into your work at all?
Clearly, in our context, it is a challenge. Because research doesn’t just mean time spent in the lab. Research implies investing more of yourself. So it’s really a challenge, and even more so in Africa. We want to claim that we have evolved. But in Africa, being a woman means being available. Even when a couple can accept [the demands on a woman scientist], sometimes it’s everyone else who complains, “You’re never here, you’re never available, you never come to social events!” I think it’s a permanent challenge. You have to tell yourself constantly, “I’m not going to complain. Oh, I’m pregnant, but no matter, I have to be at the lab tomorrow. I’m nauseous, but I don’t care.”
I see my male colleagues who leave the lab at 9 p.m. without it being a problem. Me, when I’m still sitting here at 7 p.m., I start to feel guilty. I’ve never experienced being a woman as an advantage, because you have to reconcile your family life with your daily work, which has no fixed hours. When you do research, you also have to present it, which means you’re obliged to travel. So you’re not only preoccupied with work; you are also absent from your family.
But I don’t think about it every day. When I wake up, I don’t think, “Oh, I’m a woman, I’m going to do this.” Of course, there are always children around to remind you: “Mama, you aren’t listening. Mama, it’s a holiday but you’ve just been on your computer.”
“Well, dear, I was at home all day.”
“But you didn’t talk to me!”
Even from time to time, your husband will say, “You need to stop. All you’re doing is consulting your mail.”
So love, family, and all the rest do exist. You hope that your children will grow up quickly, before you’re too old. You tell yourself that they’ll be more independent, but I don’t know. The worst is that we don’t take care of ourselves. Some people, they make themselves beautiful—they do their nails, they take care of their skin, and you want to as well! [laughs].
What advice would you give to the next generations of Cameroonian and African scientists? And to women scientists?
I’d like to say something first to our universities. We need to find a way to train our young people better. We have to improve training, to avoid refresher courses that bring people from everywhere but don’t select the best people. We have to target smart young people. If we start with ten good people every year, the impact will be substantial.
To young, upcoming scientists, I would say, “Ask yourselves questions that are most appropriate to your context.” That could be limiting, but I don’t think so. “You young scientists are best integrated into your own context. You are most motivated to pursue this kind of research, because you live our challenges here on a daily basis.” I tell them to ask questions that speak to our problems, because then we’ll come up with answers that are best adapted to our concerns.
And if you are a woman, forget that you are a woman. If you’re always thinking first and foremost that you’re a woman, you’re going to impose limits on yourself. But you need to learn to explain to your partner what you do, so that he understands and supports you. Because it’s much harder if you have a partner who doesn’t understand anything, who blocks everything. That must be hell. If you’re always thinking that you’re a woman, you’re just going to say, “I shouldn’t, I can’t.” And you’ll limit yourself.
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Giles-Vernick, Tamara, and James L.A. Webb Jr., eds. Global Health in Africa: Historical Perspectives on Disease Control. Athens: Ohio University Press, 2013.
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Marion, E., J. Landier, P. Boisier, L. Marsollier, A. Fontanet, P. LeGall, J. Aubry, B. Noumen-Djeungo, A. Umboock, and S. Eyangoh. “Expansion of Buruli Ulcer Disease in Cameroon.” Emerging Infectious Disease 17, no. 3 (2011): 551–53.
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TAMARA GILES-VERNICK is a Director of Research in the Emerging Diseases Epidemiology Unit at the Institut Pasteur in Paris. She has conducted medical anthropological and historical research in Central and West Africa, publishing on viral hepatitis, Buruli ulcer, the historical emergence of HIV in Africa, global health in Africa, the history of influenza pandemics, and environmental history. She is currently leading a three-country study on the history and anthropology of human–nonhuman primate contact and emerging diseases in Central Africa.