Pioneer for Public Health
words by Susan Glick / photograph by Pete Byron
At 30, Nandini Selvam is a pioneer in the eyes of public health experts more than twice her age, And her career is just launching.
ttracted to healthcare from her teens, she was a volunteer EMT in her hometown for seven years. At 21, she worked out of the back of a mobile medical van, distributing medical supplies in India. But it was on a service trip to the Dominican Republic during her years at UMDNJ’s School of Public Health (SPH) that it all came together. She witnessed a young, homeless girl sitting contentedly among heaps of trash coloring a single piece of paper and quickly realized not only the tragedy of poverty, but also the lesson of hope, and understood that even small improvements in public health can make large differences in the lives of individuals.
She decided to focus on the “big picture” of epidemiology, where she could potentially impact the health and well-being of many. Her former supervisor, Amy Davidow, PhD, a UMDNJ-New Jersey Medical School associate professor of preventive medicine and community health, says research in this field looks at characteristics of people afflicted with a particular disease or symptoms, and forms a hypothesis about disease causality. “For instance, where does the evidence come from that something new is afoot — such as Kaposi’s sarcoma, which began appearing in young men in the early days of HIV/AIDS? Previous to AIDS, Kaposi’s sarcoma had mostly been seen in quite elderly men. Thus epidemiological research led to important discoveries in this field long before scientists isolated the actual virus.”
Selvam was accepted for her doctorate elsewhere, but decided in favor of SPH because of the strong guidance of her faculty mentor, Marian Passannante, PhD, and the unparalleled work opportunities in cutting-edge epidemiology that were offered at the Global Tuberculosis Institute of New Jersey Medical School. She was employed there full-time during her doctoral studies, participating in the Tuberculosis Epidemiologic Studies Consortium (TBESC), a CDC research initiative. In collaboration with Davidow, she worked with local residents to analyze potential risk-factors and barriers to the care faced by foreign-born patients, studied why some individuals have a prolonged period of testing positive with no symptoms of active disease, and looked at TB transmission patterns. Some of this work relied on questionnaires translated into 13 languages, including Spanish, French, Tagalog, Hindi, Vietnamese, Chinese and Haitian Creole.
“I was able to practice epidemiology at the ground level, and learn how fieldwork is conducted. Understanding what it takes to interact with a patient in-person is worlds away from reading about that patient at your desk,” says Selvam.
In addition, she was the only member without a PhD or MD to serve on the original TBESC Executive Committee. “But, really, I was just a fly on the wall,” she states modestly.
“When we hired her, we knew Nandini was very talented, but we had no inkling that she would be a pioneer,” says Lee Reichman, MD, MPH, Global Tuberculosis Institute Executive Director. “She was the first PhD student in the SPH Newark program and was able to parlay a natural synergy between her studies and her work into important research in TB, and ultimately into a coveted and highly competitive position in the Epidemic Intelligence Service (EIS).” Selvam credits her success at UMDNJ not only to all those with whom she worked at the institute, but also her mentor Dr. Passannante.
For those not in the know, the EIS was established in 1951 as an early warning system against biological warfare and man-made epidemics and has now evolved into a worldwide surveillance and response unit for all types of epidemics, including chronic disease and injuries. According to its website, EIS medical doctors, researchers and scientists serve in two-year assignments as front line “disease detectives,” determining the cause of, and controlling, thousands of disease outbreaks and health challenges, including Legionnaires’ disease, AIDS, Ebola virus, poor nutrition and birth defects. EIS was crucial in the global eradication of smallpox and, more recently, garnered significant attention for contributing to the containment and control of anthrax following the attack on the World Trade Center on 9/11.
Since joining the EIS in 2006, Selvam has flown across the world. Assigned to the Division of Sexually Transmitted Diseases (STD), Epidemiology and Surveillance Branch, she has worked on STDs within the U.S., and is currently studying the relationship between STDs and HIV in Mozambique. According to the CDC’s Global AIDS Project (GAP), Mozambique’s battle against a 16 percent adult HIV infection rate is hampered by, among other things, a severe physician shortage and an adult literacy rate of 46.5 percent.
Selvam’s project will determine a baseline prevalence of STDs among HIV positive individuals. Based on the results, in collaboration with the Mozambique Ministry of Health, she will determine if there is a need to adjust management of these individuals at a national level. Her results and recommendations for implementing healthcare management guidelines will be owned by the Mozambique government. “Most of my work is done outside of our federal government’s jurisdiction. Whether I work in the U.S. or another country, I basically have to be invited there. The CDC is considered technical assistance. My goal is to contribute to Mozambique’s ability to successfully manage HIV infected patients with STDs.”
Does she think she’s made it, presenting critical epidemiological findings at a national level to a country in need? Yes and no. She knows she has advanced at a young age in a career for which she feels perfectly suited. Yet, when she considers her colleagues at CDC and partner organizations, she sees how far she still has to go.
“It is very humbling working with my counterparts in Mozambique. They have achieved so much for this young country. I thought I would know a lot when I received my masters and then my doctorate. But now I realize that I don’t know that much. I still have a great deal to learn.”