An indelible experience in Kenya influences a life’s work.
For many physicians and researchers, an indelible experience in the early days of training can shape an entire career. For Associate Professor Lucian “Luke” Davis, it was working at a hospital in Kenya that lacked basic resources.
“It was devastating,” Davis, M.D., M.S., recalled. As a pulmonologist, one of the main challenges he faced was diagnosing tuberculosis (TB). “We wondered, do these patients have TB, or do they have one of the many opportunistic infections that we always struggle to diagnose?” Davis has dedicated his career to changing what he saw during his first experience in Kenya, researching solutions for diagnosing TB in a timely, sustainable way.
“Half of all patients cannot be diagnosed with the most widely available test (sputum smear microscopy),” he said. The test still used widely in Africa has not changed significantly since its invention in the 1880s. While new and better tests exist, Davis said, most are not widely available in Africa and, as a result, many people die needlessly.
In 2016, 2.5 million people fell ill with TB in Africa, accounting for a quarter of new cases worldwide, according to the World Health Organization. The disease spreads quickly and those infected are often symptom-free initially, which delays treatment. “Up to 60 percent of people with tuberculosis don’t show any symptoms at all,” said Davis. In densely populated areas, people with active TB can infect multiple other people over the course of a year.
Davis helped organize the Uganda TB Implementation Research Consortium (U-TIRC), which is committed to improving the diagnosis and treatment of TB and other infectious diseases in Uganda. There, he works with collaborators at Makerere University, in Kampala, where U-TIRC is based, as well as with Ugandan public health officials and researchers from a variety of disciplines from Uganda, the United States and the United Kingdom. He also co-founded Walimu, a nonprofit organization in Uganda that works to eliminate preventable deaths in hospitals.
“Tuberculosis has evolved to take advantage of poverty,” said Davis, and at U-TIRC and back at Yale, Davis is focusing his work on how to overcome this and other barriers to care. Through the field of implementation science, he is applying knowledge gained in Uganda to finding sustainable, cost-effective and patient-centered public health interventions.
While evidence-based practice has become the standard in medicine and public health, Davis said, that evidence, while crucial to understanding disease, is generated through research in tightly controlled environments. There is often a disconnect between findings and the unpredictable nature of the world into which these findings must be translated. “Implementation science is about how we overcome some of those challenges in moving from evidence to practice,” he said.
Davis has become involved in the newly launched Yale Center for Implementation Science, teaching a course and mentoring scholars using the example of his own ongoing research in TB diagnostics. “If we had better diagnostics, it would spark a revolution in our understanding of local epidemics and in how to provide services to people,” he said. “And whatever we learn from how we deliver services for TB could benefit other diseases as well.”