These trailblazers bring hope and optimism to the future of biomedical research in their homelands.

By Corie Lok

As one of only about 100 psychiatrists in Kenya (a country of 53 million people), Dr. Felicita Asha Omari has worked for years in both the mental health and child and adolescent health departments at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. She often wondered why some children suffered developmental health problems while others didn’t, even if they grew up in similar environments. For Dr. Jackline Mmochi, also a psychiatrist in Kenya, she wanted to know more about the molecular causes of the mental illnesses she was treating in her patients. 

This desire for deeper insights has inspired Omari, Mmochi, and 22 other clinicians and early-career scientists to date in Ethiopia, Kenya, South Africa, and Uganda to join a neuropsychiatric-genetics training program called the Global Initiative for Neuropsychiatric Genetics Education in Research (GINGER). This project, which aims to increase the number of neuropsychiatric geneticists working globally, currently involves researchers at Addis Ababa University in Ethiopia, Moi University and the KEMRI | Wellcome Trust Research Programme in Kenya, Makerere University in Uganda, and the University of Cape Town in South Africa, and the Stanley Center for Psychiatric Research at the Broad Institute, and is led by Harvard T.H. Chan School of Public Health assistant professor Lori Chibnik.

GINGER, which runs alongside the NeuroGAP-Psychosis program, is training research fellows to be able to independently run psychiatric genetic studies and analyze psychiatric genetic data and more broadly, to push the envelope for mental health research in their countries, and to participate in global conversations about mental health research.

GINGER has trained 17 fellows — including Omari and Mmochi — from four African countries since 2017; another seven started the program this year. One member of the first class of fellows, Dr. Allan Kalungi, hopes to be one of the first neuropsychiatric genetics researchers in his home country of Uganda.

The basis for the GINGER curriculum was developed by all collaborating scientists and is consistently informed by the needs of the fellows and priorities of collaborating institutions. 

“We wanted to address the future needs of people across Africa, such that when members of my generation are no longer doing this genetics work, there will be people who can continue it here,” said Professor Lukoye Atwoli, a NeuroGAP-Psychosis principal investigator, GINGER collaborator, and professor of psychiatry and dean of the Aga Khan University Medical College, East Africa in Nairobi, Kenya.

NeuroGAP-Psychosis investigators are also using some of their research project funds to train seven graduate students for careers in biomedical and clinical research. 

NeuroGAP-Psychosis and GINGER are among several programs training the next generation of geneticists in Africa, including the African Centre of Excellence for Genomics of Infectious Diseases, based at Redeemer’s University in Nigeria, and the Human Heredity and Health in Africa initiative (H3Africa).

Mmochi, Omari, Kalungi, and two NeuroGAP-Psychosis-funded graduate students spoke with us about what their training means for them and for African biomedical research.
 

Dr. Jackline Mmochi,
GINGER research fellow and psychiatrist, Iten District Hospital, Iten, Kenya

Kenya is a country where we have a cultural perception of what causes mental illness. We are still struggling to convince people that this is a medical illness like any other, and there are treatments for it, and the treatments can work. I think studying genetics is the way forward to trying to unravel this mystery around the mind. If we don't do that, then we can never bring science to mental illness.

In the future, I think patients here will be attended by a very well informed clinician. So I may tailor my management to this particular patient, not to everybody else or to what the medical books are saying.

In the next five years, I hope I'll be at a teaching institution, so that as I see patients, I keep on passing the knowledge to undergraduates.
 

Mowlem Pierre,
lab manager and master's student, MTRH/AMPATH, Eldoret, Kenya

I was already a part of NeuroGAP, working in the lab to extract DNA from patient samples. I was thrilled to get a NeuroGAP-Psychosis scholarship. I’m now studying immunology as part of a master’s program.

I’m really interested to know the science behind psychosis, because it's becoming common within our population here. 

I'm basing my study on the immunological aspect of psychosis, together with the genetic aspect. I'm going to look at gene polymorphism and tumor necrosis factor alpha. Since tumor necrosis factor alpha is an inflammatory mediator and it's common in psychotic patients, I'm trying to look at the science behind it and what influence it brings.

I think with this work, if the results come out positive, I think it'll be an early indicator of disease in these neuro-psychotic patients. I hope we can identify this inflammatory mediator early enough so that interventions can be done much earlier for patients.

Dr. Felicita Asha Omari,
GINGER research fellow and psychiatrist, MTRH, Eldoret, Kenya

I wanted to learn more about psychiatric genetics because of my passion for children and child health. If we are able to identify children at risk of developing a mental disorder early enough, can we change the course for them?

Being able to work with genetics data makes me feel very empowered, because then I'm not just a clinician, I'm a clinician who understands the data, and my clinical practice is based on that data.

Moving forward, we need to pass on the knowledge to the next generations of students, who are going to benefit from that knowledge. And so it becomes much easier, and even cheaper to conduct the studies here and eventually we won't have to transport DNA to the US for analysis. We will be able to do that here. 

I think that's the overall benefit: leaving people not just with the knowledge but also with the ability to do genetics studies themselves.

Dr. Allan Kalungi,
GINGER research fellow and biochemist, Makerere University, Kampala, Uganda

I'm a biochemist by training but now I'm interested in neuropsychiatric genetics. I'm looking at gene-environmental interactions in mental disorders in HIV-positive children and adolescents in Uganda.

I am very proud to be part of GINGER. I think it's going to have a very big impact on me. It  already has. It's given me the skills I’ll need as a researcher.

I think GINGER is already creating a big impact because they're training the first neuropsychiatric geneticists in Uganda. Our group is the first, and we are getting the skills to be able to conduct neuropsychiatric research. I think that is a very big impact on Uganda.

In 10 to 15 years from now, I see myself as one of the leaders in neuropsychiatric genetics on an African continent. And I see a vibrant neuropsychiatric research community growing in Uganda. 

Dr. Mohamed Aden Hillow,
psychiatry master's student, Moi University/MTRH

It is an honor and a great opportunity for me to be involved in NeuroGAP-Psychosis, given that genetic studies are hard to come by in this part of the world.

My master’s project is to look at traumatic life events that have happened to people and the relation they might have to the current psychosis patients are having. Is there a link between the two? So I’m doing a case control study with patients and controls we are recruiting.

The NeuroGAP-Psychosis project is helping me to get data and also to get mentorship from the PIs and co-PIs. I hope to acquire the necessary skills and knowledge to be able to conduct a genomic study in Kenya to further bridge the knowledge gap. 

Through my current research work, I hope to deepen the understanding of trauma and psychosis. If, for example, we establish that there is a link between the two, this will inform policies aimed at curbing the traumatic events found to be associated with psychosis, and it will address public health issues. 

 


Interviews conducted by Tom Ulrich in November 2019