I grew up in León city, Nicaragua. León is known locally as the home of the oldest university in Nicaragua and it is located very close to the Pacific Ocean. The lack of a formal education makes it difficult for many people to succeed in Nicaragua. My mother had a very clear goal in her life – to work hard to ensure she was able to give her children a good education and a better future compared to her own. She instilled in each of us an intense desire to study and work hard to reach our goals and desires. Telling us: “there is nothing impossible to achieve if you work hard”. I realized that I wanted to become a doctor when I was in the fifth grade. My uncle had passed away from a rare disease and I knew at that time that I wanted to devote my life to help people. In order to achieve my dream of attending medical school, I needed to dedicate myself to my studies. In Nicaragua, like other countries, only students with the highest marks are competitive enough for medical school.
Years later, I was admitted to medical school in one of the most prestigious universities in Nicaragua, the National Autonomous University of Nicaragua, León (UNAN-León). After I completed my medical training, I conducted post graduate work in epidemiology and occupational medicine. I eventually became a research assistant at the Research Centre on Health, Work and Environment (CISTA) at UNAN-León, where I gained valuable skills designing and conducting epidemiological studies. During this time, I felt the need to move to the next level of my educational goals and pursue my dream of obtaining a PhD abroad, outside of Nicaragua.
In 2016, I began my doctoral training at London School of Hygiene and Tropical Medicine (LSHTM) in London. I was fortunate to train and learn under three well-known scientists to tackle a research question I am driven to answer: chronic kidney disease of unknown etiology (CKDu) in underdeveloped countries. The aim of my research project was to advance the understanding of the causes of CKDu using a number of epidemiological research methods. I completed my doctorate in two years under my mentorship team and I am currently a senior lecturer and researcher at the Faculty of Medicine at CISTA and Research fellow at the Centre for Nephrology at University College London.
During my journey, I had to overcome many obstacles such as academic challenges, language barriers and family separation. I did not let these challenges become an impediment to reach my goals and have advice for those who wanted to embark on this amazing adventure. This journey was not an easy one especially coming from an underdeveloped country. Therefore, I want to share a few tips and strategies to help others in their quest.
Find a research project that you are passionate about- If you want to embark in a PhD program, pick a research topic that you are excited about as you will be working in that area for many years to come. For example, I decided to pursue a research project on CKDu for two reasons: first, I became fascinated with the kidney when I was studying medicine. Second, there is a devastating epidemic of CKDu in my country (primarily in the lowlands of the Pacific coast of Nicaragua) that has killed approximately 20,000 young agricultural workers and thousands are being affected. What is even more concerning is how CKDu is primarily affecting those with lower socioeconomic status. This disease is characterised by the absence of proteinuria, high blood pressure or diabetes. Despite many epidemiological studies that have been conducted to reveal the cause of CKDu, it still remains a mystery. My desire is to find the cause of CKDu. This is my passion and I plan to spend my career working on this topic because of the urgent need to understand and eventually stop CKDu from developing in the first place.
Good mentors are key to success- The key point to success is to find good mentors. For example, the way I met with my supervisors was unusual. I attended a formal meeting about CKDu at LSHTM in London discussing the feasibility to implement a research project in Nicaragua. This meeting was attended by a multidisciplinary research group (nephrologists, epidemiologists, occupational experts, etc) and it was my opportunity to develop networking and explore the possibility to study this problem. At the end of the meeting, three attendees invited me to a discussion and eventually offered to mentor me during my doctoral training. I was ecstatic and immediately said yes. They were my inspiration to work very hard and learn more and more every day and never give up. My mentors challenged me to develop new ideas, and create solutions to existing problems.
Overcome obstacles that come your way- Studying abroad poses many challenges and barriers for a student to overcome. This is especially true for those coming from low and middle-income countries. For example, students from low and middle-income countries rarely learn to be critical because they typically study in a traditional education method where teachers give didactic lectures and students learn by answering questions based upon rote memorization. This lack of critical thinking was a limitation for me during the first six months of my doctorate studies. I found it challenging to constructively critique scientific papers and even more challenging to openly debate topics with other students. In order to surmount this obstacle, I spent an a lot of of time reading the scientific literature. I used checklists to identify the strengths and limitation of research studies in order to become more critical of the literature. I recommend that all students interested in pursuing clinical research become avid consumers of the medical literature. This will go a long way.
The language barrier poses unique challenges- The biggest fear of a student who is planning to study abroad are the unique cultural and language barriers imposed on them. This was my (and many others) biggest obstacle to overcome. In fact, the language challenges pushed me into an existential crisis. I tried had to push through this obstacle and pushed hard to overcome this fear. I realized that learning another language was another opportunity to learn and grow. First thing I did was to take private English lessons, during my free time I read, listened to the news, and spoke with my classmates. These steps helped me overcome my language barrier and by six months into my training program I was feeling much better. I suggest immersing yourself in the local culture and practicing the language with native speaker and do not let these barriers stand in the way of reaching your goals.
Family separation is common and difficult- Leaving family is probably the most difficult part in any journey abroad. The majority of PhD scholarships do not include enough support to allow for your family to relocate with you. Thus, studying abroad often leads to families being separated by long distances. This can lead to personal instability causing significant relationship stress (with a significant other or with children). All of these factors can have negative consequences to your research progress, especially during a demanding doctoral program that demands high concentration and commitment. Therefore, it is imperative to keep in close contact with your family during this stressful time..
In summary, my PhD journey was an incredible journey. I learned that between the earth and the heaven, there is nothing impossible to achieve. All of this was possible because my mentors and family encouraged me to learn every day in order to achieve my goals. My advice is to work hard, be open to constructive criticism, surmount your fears, be persistent, open minded, and learn from others. Good luck.
Post by: Marvin Gonzalez-Quiroz, MD, MSc, PhD
NSMC Intern, Class of 2019
Mentors: Hector Madariaga, MD
Annabel Biruete, PhD