ASAP Awards – Interview with Nitika Pant Pai

Communities with limited wealth suffer of diseases in a way that many of us may never come to be confronted with. Poverty befriends disease, and many diseases befriend shame.

Nitika Pant Tai knows this well and is dedicated to do something about it. She was one of the finalists of the ASAP awards for developing a phone app that will lower the barriers for HIV testing by removing the shame that usually comes with going to a clinic for the test. The phone app will help people do the test at home and connect with the right people and information.

Image courtesy of ASAP

I asked Nitika a few questions, and this is what she had to say:

Q. Can you tell me a bit more about the app?

NPT: I won the award for the HIV self -screening strategy and innovations developed for it. The app is part of that . The App is copyright protected and so we haven’t publicly released it yet.

It is an Android Google application (globally portable) that guides anyone who wishes to self test through the process of self-testing. Teaches them on what they need to know information on HIV, walks them through self test process (conduct and interpretation)  and linkages to clinics and counseling can also be operationalized with it. It works with an oral HIV self-test. Currently in English but will be translated into several languages and platforms.

Q: How closely have you been working with the target group for which you developed the app? What has their response or involvement been in the project?

NPT: For the past 12 years, I have conducted clinical research in HIV in marginalized populations worldwide (i.e., incarcerated populations in USA, STD clinic attendees and pregnant women in India, IDU’s and immigrants in Canada). I have also led and completed research projects in students and health care workers in Montreal and South Africa. So, I have been in touch with the needs of various populations in different contexts and settings.

To develop the application, we first started out with a paper application that we evaluated in different populations –formally as part of clinical studies and informally by introducing it to different groups- counselors, patients, providers for feedback. Then, we were funded by Grand Challenges Canada to conduct a study in South Africa. So we further refined our application- created an Internet application and tested content formally in a study in health care professionals. After doing that successfully, we converted it to a smartphone application and tested that for design, user interface, usability features. We are now trying to customize the application for various countries ( i.e., India, South Africa, Canada, to name a few)

I was thinking of s global self-tester when I thought of an app. I sought feedback from the HIV community – from patients, from my colleagues (HIV clinicians), from public health professionals, and from  people (that included members of my family-who are not into medicine, but familiar with apps). We showcased a first prototype at the London Self testing group, followed by GCC conference in Ottawa, and most recently at the International Aids Conference, in Kuala Lumpur. After a positive feedback , we decided to customize it for different settings and cultures for wider global applicability.

Q: How widely do you see this approach being adopted?

NPT: After showcasing it, I was convinced that there is a niche for it. I received requests from various groups (research groups, foundations, industry, and public health agencies)  so I do foresee it helping many people and I think it will be adopted by the digital savvy people.  We have different applications for different audiences.

Q: Going through your website, I found out that your focus is not just on HIV. What is it about those diseases that attracted your attention?

NPT: I have been involved in diagnostic research with point of care technologies for HIV and related co-infections (i.e., Hepatitis C, Hepatitis B, syphilis, TB) for about a decade now. I have focused on diagnostics and treatment issues around HIV. I had led Implementation research in both developed and developing settings.

Related diseases have attracted my attention, because often times, we fail to do a good job of diagnosing, treating or controlling HIV alone and people die from others (Hepatitis C, TB).  I have a passion for solutions to improve Women’s Health ( developing countries) and I am working extensively on that now.

Q: Do you think there is a potential to build similar apps for a broader range of diseases?

NPT: Of course! There is always an app to fill a gap! I have several now in my mind…wont spill the beans today 🙂

Q: How did you come to be involved in this line of work? Was there a trigger at some point that made you place your attention onto this line of work specifically, or was this just serendipity?

NPT: I am a trained medical doctor with a doctorate in research methods- and a masters in public health- my broad training helps understand all sides of the health spectrum. I realized early on in my career that treating patients can only go so far, and that my calling lay in treating and improving health systems- it didn’t happen like it happened for Gautama Buddha –under a tree– but certainly a lot of soul searching and introspection—deep introspection of your calling in life. And it happened at this magically transformational place called Berkeley, California. US offered me so many choices and wonderful people who served as great role models—so choices created confusion, but meditation helped zone in. This realization of my calling was fuelled and solidified when I enrolled into an MPH program at the University of California at Berkeley- It took me on a tangential track of academic research, a PHD in Epidemiology and Biostatistics and a deep interest in understanding the HIV epidemic –followed by a fellowship in infectious diseases and trials at McGill University, Canada. Several role models at Berkeley and San Francisco, Dr Jackie Tulsky, the late Warren Winkelstein, Art Reingold,  Jack Colford, Ira Tager were all physicians who changed their career tracks to public health and research inspired me. They supported me in plunging into my calling in life.  My husband, Dr Madhukar Pai was my constant support and role model and he encouraged and supported this radical shift from clinical surgery to public health.

After stepping out of my physician’s coat and all that comes with it—I began to listen to people– to patients, to front line health care workers, to staff. By listening to their woes, I realized I could help them by being their advocate. It wasn’t about what I wanted to prescribe them; it was about what they wanted to prescribe me for their betterment. That was a paradigm shift. It did teach me humility. I was way too arrogant before. I thought I fixed the clinical problem and that did it, sadly, it didn’t.

I continued with the line of research, when, I started out as a graduate student. I appreciated research  and now I teach clinical research methods to residents at McGill University and try to inspire them to think more…

The big picture issues of developing strategies for dysfunctional health systems that impacted several lives appeared more challenging and impactful to me, and fascinated me—I knew I could come up with solutions… Having seen them in close quarters in India.  After trying to understand US, Canadian and South African health systems, the functionalities, the ecosystem, and the dysfunctionality, (both the yin and the yang)  I thought harder about what I could do through implementation research and now, innovation.

I love working with people from all different backgrounds and I have a deep passion for the field of medicine and public health and love to solve these big problems that are complex, dysfunctional, complicated . I synergized all three.  Thankfully, my research got funded by Canadian Institutes for Health Research, and by the Gates Foundation. And innovations and challenging out of the box approaches got funded by Grand Challenges Canada, so these propelled me in the right direction. I conducted experiments in different settings: India, US, Canada,- South Africa. Each country presented its problems and its health systems. but—the a common denominator that we create solutions for is a human life!

My current project is a natural extension of my decade long independent work on oral fluid diagnostics for HIV.  I evaluated the accuracy of this test in tough rural settings in India. I developed an innovative strategy with oral self tests for women in labor, performed a meta-analyses on accuracy of these tests for self testing then moved on to evaluating self testing strategies. Armed by solid evidence, and training in methods and clinical disciplines, I designed strategies.  One thing led to another.  And then Grand challenges Canada happened. It sparked the innovator geek in me.  I wanted to do something different, and with GCC funding and support for out of box approaches, I pursued it. Solidified by evidence that I collected myself—after having convinced myself—I went ahead with that conviction.

I listen to no one but myself—very stubborn– you would say.  Even if I am in the wrong—I learn by making my own mistakes. My parents have always let me be-a philosophy that I carry on with my students, trainees and my own child. And I believe in old world values of universal good and cross cutting solutions that impact all people across the world.  I believe in Karma and destiny.  I am a visionary and a right brain dominant physician scientist, I imagine solutions of the future. I also love painting and cooking and writing poetry, my right brain balances my  analytical left brain.

Q: Would you like to say anything about the broader topic of being a woman in this line of work, or about how your ethnic identity/history influences the way you go about your career or ow others may perceive you because of that?

This is one of my favorite topics. I think it is a chapter in itself.:-)

In Canada, there are many women in medicine and science. So, I don’t face any gender bias on a daily basis. But when I travel and work in other cultures, there are few women, then I do. So you do face egos and have to keep reacting to that in check. Sometimes, you need to dissolve your own ego  to understand where sexist opinions come from.

Women in my line of work need to believe that they can do justice to themselves and to their careers—they need to be grounded and be tuned in to their own needs as well as to the needs of their families. Often times their days and months wont be perfect, their homes wont be perfect, they would feel totally exhausted, but they need to give in to that imperfection to enjoy their lives.  We women learn to Juggle—but learn to switch off- for your families—for yourself—because no one dies for work–

I am a strong feminist—I grew up in an overtly gender biased society in India, before I moved to North America, where I experienced another form of bias—of being perceived as different (ethnically different). Thankfully I moved around in an academic circle, where people are exposed to other cultures and are more forgiving, so they didn’t make me feel like the odd one out. But you have to learn to ignore that uncomfortable bit!

I believed all along that men and women were equal. Women are naturally talented, but because of centuries of suppression in other cultures, and negative self talk, self esteem issues,  and pain body as a consequence—they oftentimes give up!—even before running the race… sometimes they seek satisfaction elsewhere- I am happy to be in an environment at McGill where 50-60% of our divisional faculty are women. Strong women with strong careers and families who have inspired me that it is possible to have both….. and you have to juggle to do what makes you happy.

McGill University also embraces diversity and provides a great environment to work in for people from other cultures. So I love working there. I inspire other women now- some of my trainees suggest I become a motivational speaker or coach for them. 🙂

I believe that everyone on this planet is equal regardless of their DNA or the color of their skin or their background. I come from a family of educated professionals (lawyers, administrators, healers) a family with about 2-3 generations of educated men/women. And thankfully, progressive fathers and grandfathers, who believed in gender equality, so the confidence in  myself as a woman stems from it. My parents (both my mom and dad) raised me with a strong value system of honesty, integrity and hard work. So I never doubted my capacity —but I had to be careful in a overtly gender biased society in India and in a different society in North America, where I am perceived to be different.

If people treated you differently, it was a problem of perception.  It is easier to think of an immigrant stereotype-—and I understand that. But you know US and Canada are built of and with immigrants—the term being an immigrant is relative, and is a function of time when you arrived—sometimes that varies in years, or, sometimes in centuries. But for the immigrant hard working work ethic, and strong values, they would not be a land of choices and opportunity.  So it is all about our mindset and how we view the world. And in today’s day and age, the world is very small!! People from America live and work In Asia. The boundaries are more blurred.

As for myself, I continue with my work—ignored the perception—:-)

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