Faculty React to Attacks in Mumbai

Several UCSF faculty who have partnerships in Mumbai, India, are reacting with shock and sadness to the recent three-day terrorist siege in the country’s financial capital. Arun Sharma, BDS, clinical professor in the UCSF School of Dentistry, was in Mumbai this summer, discussing a possible partnership between the Indian Dental Association and the UCSF School of Dentistry. “To see the Taj Hotel in flames was shocking and brought back memories of 9/11 and New York. South Mumbai, where I grew up — Oberoi, Taj, Leopold’s, VT station, all within a few miles from my parents’ house, all places that I visited this summer with my daughters — made me think, Was this true or a bad dream?” said Sharma. “My reaction was fear for those in Mumbai and then anger at the terrorists. Then, as I thought about it further, I realized we can’t give in to ‘fear and anger,’ the main objective of the terrorists.” The idea behind forming a relationship with the Indian Dental Association is to provide a forum for knowledge exchange. This is directly linked to the idea of collaboration and capacity building, as stated in the UCSF Strategic Plan. In evaluating whether the attacks would impact the developing relationship, Sharma said, “Atrocities against humans unite us. We need to form new partnerships with the people of Mumbai — to make us all stronger and not let the terrorists succeed by dividing us.” Mumbai is home to a growing number of international conferences attended each year by UCSF faculty. The Bixby Center for Reproductive Health Research & Policy will be a part of a conference on gender violence this spring, and from March 8 through March 12, 2009, the city will host the World Conference on Tobacco OR Health, where leaders from UCSF are scheduled to give presentations. Despite recent occurrences, UCSF faculty members believe it is important to maintain a broader perspective of all global health partnerships, including those in India. “It’s a scary situation because the World Conference on Tobacco is scheduled to be held at the hotel that was attacked, but it is important not to allow these terrorists to disrupt the battle against the multinational tobacco companies,” said Stanton Glantz, PhD, a professor in the School of Medicine and director of the UCSF Center for Tobacco Control Research and Education. “Big Tobacco kills 5 million people a year, and we can’t let terrorists scare us into not addressing that.” Mumbai has been the site of several UCSF research trials over the years. The Center for AIDS Prevention Studies (CAPS) faculty formed partnerships with a number of Mumbai institutes, including the Lokmanya Tilak Municipal Medical College, to examine high rates of HIV and sexually transmitted disease. Findings from research conducted in Mumbai were among the highlighted presentations made by CAPS at the 2008 World AIDS Conference in Mexico City. “I feel very connected to the city, having done research there since January of 1995,” said Maria L. Ekstrand, PhD, an associate adjunct professor in the Department of Medicine and a CAPS researcher. “Terrorism is a global problem, and I sincerely hope that the recent violence won’t impact future research trials or Indo-US research collaborations. There are a lot of opportunities and a great need for more HIV-related research in India.” India has long been home to communal violence, which directly impacts many of the underserved communities where UCSF’s research trials take place. Researchers believe that developing a deeper understanding of the context in which the research study is to take place can often lead to greater awareness that not only supports the trial, but can better ensure an investigator’s safety. “I think it’s absolutely crucial that American investigators team up with Indian collaborators,” said Ekstrand. “A major challenge is that many of us aren’t familiar with the country’s history or culture, both of which are crucial to conducting a rigorous study in a culturally sensitive and appropriate way.”

Awareness, Not Avoidance

UCSF leaders point out that, when attempting to support the University’s mission of advancing health worldwide™, developing an awareness of unstable conditions and then coming up with a safety plan is more appropriate than avoiding forming partnerships in a country. “International research studies are difficult and complex in the best of circumstances; adding substantial security concerns only increases their complexity,” said George Rutherford, MD, director of the UCSF Institute for Global Health and of the international core of CAPS. “Investigators need to be cognizant of potential threats and plan appropriately. Recent events in Mumbai highlight lessons learned in Kigali, Rwanda, in 1994 and other places. We need to have our ear to the ground and have appropriate contingency plans in place.” Despite the deadly attacks, UCSF experts believe India continues to provide an ideal location to further many of the visions stated in the UCSF Strategic Plan. The country carries a large percentage of the world’s burden of disease, especially in the area of infectious diseases, such as HIV and malaria, and reproductive health concerns. The large English-speaking population and democratic government allow for support in forming partnerships. Leaders point out that the safety of UCSF faculty and trainees who are working abroad is the responsibility of both the individuals working and those governing their role. “The best hope we have in progress against AIDS and other diseases is research appropriate to each affected community. Clinical trials in many regions are critical, despite political and security conditions that are under stress,” said Paul Volberding, MD, professor and vice chair of the UCSF Department of Medicine, chief of the Medical Service at the San Francisco Veterans Affairs Medical Center, and co-director of the UCSF-Gladstone Institute of Virology and Immunology Center for AIDS Research. Following the Sept. 11, 2001, attacks in the United States, UCSF, among other universities, increased its security strategy on campus. As UCSF expands its Global Health Sciences programs and the number of researchers interested in working in India and of trainees eager to gain international experience continues to rise, security issues become of increasing concern. UCSF’s approach both at home and abroad is to develop strategies that address these concerns, but also remain focused on its mission. “Research in India is vital, given the country’s size and complexity, even in the face of the threat of terrorism in Mumbai,” said Volberding. “The National Institutes of Health is the sponsor of most research, and universities like UCSF must balance the need for continued investigations with the safety of the staff and volunteers. Each situation must be considered carefully to decide if the risks can be managed or if studies need to be temporarily interrupted. Still, UCSF needs to work in many regions to meet our mission of advancing health worldwide™.”