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Lessons from the Pathology Lab

How lab work in India changed the way I think about science.

Every time I go to India, my grandfather asks me what I want to be. Over the years I’ve answered astronaut, paleon­tologist, mathematician.

Math major Shaunak Kishore ’12 plans to pursue a doctorate in applied mathematics.

Three summers ago, I went to the state of Bihar having just finished my high school’s AP bio class. When I arrived at my grandparents’ home in Muzaffarpur, I couldn’t stop talking about the fantastic experiments we had done. My grandfather, a surgeon, suggested that I look for work in his hospital, and I quickly agreed.

I found a job in the Modern Diagnostic Lab, a pathology lab affiliated with the Sri Krishna Medical College and Hospital. Like any student just starting lab work, I spent most of my time on basic tasks. In the ward, I took blood samples from new patients; if they needed to stay, I sent them to an open bed. For a while I worked in the culture rooms in the back, making bacterial smears and flaming plates using many of the techniques I had practiced that spring in my Pennsylvania high-school lab. This lab’s protocols, however, were no longer simply classroom rules. Getting distracted and making mistakes meant wasted resources at best, delayed diagnosis at worst. Although this thought initially scared me and slowed my hand, before long the work became routine.

But there were inevitably moments that shocked me into remembering where I was. In the afternoon I would spend time with Dr. Anand Mishra, the head of the lab. One day’s lesson was white-blood-cell-differential counts: he showed me what each granulocyte looked like, and I tallied the types on a slide. It was easy. But when I showed Dr. Mishra my numbers, I saw the look on his face. His count confirmed that his patient clearly had an infection, and would require further tests.

The specter of drug-resistant bacterial infection hung over the pathology lab. Although Sri Krishna was one of the better-­provisioned centers in the state, treating diseases such as drug-resistant tuberculosis was still very hard. The lab had some second-­line antibiotics on hand for people whose infections resisted first-line treatment, but they were expensive and in short supply. Meanwhile, patients bothered by side effects often stopped taking their medicine prematurely once symptoms disappeared, a practice that can make the treatment ineffective. So patients were required to travel to the lab’s clinic three times a week to take the drugs under supervision–a big obstacle to those living in the surrounding rural areas. Dr. Mishra enticed them by offering a free meal with the antibiotics.

Most clinics could not afford such a measure. Yet when patients stop drug treatment prematurely, TB bacteria may become resistant even to the second-line drugs. Adding more drugs to a failing treatment merely encourages more strains of multidrug-­resistant TB, which are increasingly prevalent in India. The drugs required to treat these strains can take up to two years to be effective–and aren’t even available in many Indian clinics. Given that sobering reality, some Indian doctors have proposed focusing resources on treating multidrug-resistant TB in several large cities, using a strong cocktail of five second-line antibiotics.

A few years after my summer in the Modern Diagnostic Lab, I built a mathematical model of TB to simulate the epidemic’s spread. I used the model to test the effectiveness of the city-focused strategy and found that while it would reduce the prevalence of the disease in the short run, it would not protect against the incidence of drug-resistant cases; eventually, drug resistance developed in smaller towns would overwhelm the cities as well. Entire regions are threatened by epidemics in the worst-hit towns, just as our health in the United States is jeopardized by the spread of drug-resistant infection in India.

After my time in the lab had come to an end, my grandfather wanted to know if I had finally come around: “Abh doctor ban jana soch reho?” Are you thinking of becoming a doctor?

No, I answered. I was–and still am–too enamored of academic life. But my experience in the lab certainly changed the way I think about science. My technical write-up of the epidemiological model–useful though it may be–can never do justice to the pressing nature of the challenge, nor can it convey the devastation to the lives of those affected by an epidemic. I hope that whatever career I end up pursuing, a sense of urgency about human problems will always drive my work.

Math major Shaunak Kishore ‘12 plans to pursue a doctorate in applied mathematics. Read his essay “The Next Great Plague,” which won a Goldman Sachs Foundation prize in the youth category for excellence in international education at http://www.technologyreview.com/article/22468/.

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