Lab Voices

Ann Nelson Interview (Part 1)

• Pathologists Overseas • Season 1 • Episode 5

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Dr. Ann Nelson is a pathologist who is a member of the working group here at Pathologists Overseas. She has had a long career in global health. Dr. Nelson completed medical school in Mexico and served as a chief of the pathology laboratory for the International AIDS Project (Projet SIDA) in Kinshasa. 

Tim:

Hello and welcome to the Lab Voices podcast from Pathologists Overseas. This is Tim Amukele, president at Pathologists Overseas, and I am pleased to introduce our guest today, Dr. Ann Nelson. Dr. Nelson is a pathologist who is a member of the working group here at Pathologists Overseas and has had a long career in international work that started right in the beginning. She grew up in Southern California, completed medical school in Mexico, and served as a chief of the pathology laboratory for the International AIDS Project in Kinshasa, Zaire from 1986 to 1991. The story of how she left Kinshasa is worthy of a Hollywood action movie. She will share this and much more in today's podcast. I hope you enjoy this wonderful interview with Dr. Nelson.

Ann:

Hi, Tim.

Tim:

Hey, good. So, I wanna know some background because the path you've taken, to your career is very different than your peers, right? So, both in your training, you're trained in Mexico. I think it's fair to say of your generation and of your background, probably would not have considered that So, I'm interested in what shaped you. So, tell us a little bit about your childhood and some of your influences growing up.

Ann:

Well, I don't think I ever thought about being a doctor.

Tim:

Oh. Now you tell us.

Ann:

Until in college. Because nobody else in my family had even graduated from college.

Tim:

Okay.

Ann:

My mom went to teacher school, so it was a two year college, but Okay. A four year college or professional school In my direct family.

Tim:

What part of the US did you grow up in?

Ann:

Well, I was born in Montana. My parents came from North Dakota. We moved to California, Southern California when I was four. So, I really grew up in Southern California.

Tim:

Okay.

Ann:

Our parents taught us a lot at home, but, um, not as homeschooled, but just because they thought learning and knowledge were really important for anybody.

Tim:

Right, right.

Ann:

My dad worked. He was a farmer, when we were in Montana. And then when we came to California, he started working for Atomics International and Rocketdyne and helped build nuclear reactors and then eventually worked on the space shuttle. He was a technologist cuz he never took formal training. He just learned on the job.

Tim:

Okay.

Ann:

Um, When I was a kid, whenever went to the doctor, the dentist, I remember I'd drive them nuts because I wanna know what everything was they were doing, and they looked in my eyes. I wanted to look in their eyes, what, what is this? And why are you giving me that shot? What? They had to explain everything to me. So, I think I had some innate interest in that kind of stuff in high school, my two favorite classes were geography and anatomy and physiology.

Tim:

Interesting.

Ann:

That's how I really got interested in medical stuff was the anatomy and physiology class. So, when I went to college, I was trying to figure out what to do and I thought, oh, well I'll do nursing.

Tim:

And Where'd you do college?

Ann:

I went to my first two years at Valparaiso University in Indiana. It's a liberal arts, Lutheran school. Going back to my Norwegian and Swedish ancestors were Lutheran, so I'm genetically Lutheran. So, I was thinking I would do nursing or something, but they were just starting a nursing program and uh, it was gonna take me five years to finish. So, I took a semester off and then ended up not going back there and transferring. Where I finally finished college was at University of Southern California, usc.

Tim:

Okay. Okay.

Ann:

And, I actually had a psych major because in pre-nursing I'd taken all these psych courses.

Tim:

Okay.

Ann:

But I still took biology. I had biology and chemistry, double minor, and I worked my first job outta college, I trained to be a medical technologist.

Tim:

Oh. I'm just learning this about you. This is cool. I had no idea.

Ann:

Yeah. I had applied to medical school in my last year, but in 19 71, 72 was the height of the Vietnam War.

Tim:

Okay.

Ann:

And so less than one in 30 people who applied to medical school in California got in.

Tim:

Okay, and the idea was that they were trying to keep young people available for service

Ann:

Well, because people were trying to get out of the draft, so they applied to school.

Tim:

Oh, I got you. I got you.

Ann:

And I, and I worked to put myself through school, so I wasn't getting a 3.6. I was, you know, I had a B average, but

Tim:

Right.

Ann:

It wasn't high enough, so I became a medical technologist. During college, one of the jobs I had was working at a tuberculosis sanitarium in Los Angeles. And well I did work in the lab, but I also worked doing Guinea pig autopsies because Guinea pigs were used to purify the tb.

Tim:

Okay.

Ann:

And it was commonly used then.

Tim:

What was the point of that? Of using Guinea pigs to purify tb?

Ann:

Because if you had mixed cultures, the only thing that would grow in the Guinea pig was mycobacteria tuberculosis. The other mycobacteria wouldn't always grow.

Tim:

And I guess we didn't have all the different ways of separating them that we have now in terms of culture methods.

Ann:

Yeah. And sometimes you Guinea pig, you'd get a purified and then you could do the, sensitivity. Sometimes you did sensitivity testing on that. So I worked doing that. And then part of what I did, Barlow became one of the screening centers.

Tim:

Mm-hmm.

Ann:

For, Vietnamese refugees who were coming over. So they all had to be screened for tuberculosis, so I would do the skin testing and talk to them and stuff. So, I was doing a little global health back then.

Tim:

Great.

Ann:

So that was in college, and then the people who had the lab that I worked for there also had regular general hospital labs, and so I trained as a med tech, but the pathologist who was my boss, the head of the labs, said, You've been a med tech for less than a year, and I would make you the chief tech and that means that you're overqualified." He said, you should go to medical school." And he said,"I have some other friends who went to medical school in Guadalajara in Mexico, said some of his other technicians had done that. So, he paid for my ticket to go down there and interview. And then they loaned me the money to go to medical school and then allowed me to work.

Tim:

Who was they?

Ann:

The Dr. Channing. And it was a group of pathologists. There were three pathologists.

Tim:

That's awesome.

Ann:

So, out of their park clinical labs, was their consortium of their different hospital labs, including the tuberculosis hospitals. Um, so they loaned me the money to go to medical school basically interest free and I would just get money when I needed it to pay. But I also would come home and work, anywhere from 60 to a hundred hours a week during my vacations.

Tim:

Okay.

Ann:

I would take night call and work the private lab and, do whatever, wherever I could find a few hours to earn a little money, I did.

Tim:

And you would work to pay off the loan?

Ann:

I would work for money to pay my living expenses. They loaned me money for tuition. So, I didn't pay them back until after I graduated from medical school, until I was already in residency.

Tim:

This is really a remarkable story. So, I guess don't know how people paid for medical school before.

Ann:

Well, it was much less expensive. I think it was$5,000 a year for tuition and then living in Guadalajara and several of us would have group houses and shared expenses, so that wasn't, you know, it was less than 10,000 a year for everything.

Tim:

Okay.

Ann:

And then when I came home, I lived with friends or family. Well the main hospital that I worked in was a small hospital and so if you were the night tech, you would do the emergency room stuff or the intensive care stat draws and whatever. I was always involved with patients and what was going on. And the doctors always took a lot of time to explain things to me. So, I was learning a lot as I was going along and in Mexico, they had something called medicine in the community,"medicina en la comunidad."

Tim:

Mm-hmm.

Ann:

So six weeks, every semester you were sent out doing something. The first year, we did vaccination tracking in pueblos in small towns around the medical school. As we increased in years and experience, we would run small clinics. And because I was a med tech, I always got put running the lab for all these things. So, doing rural health and because it was in Mexico, was global health, the type of things that we saw were TB and Amebiasis and typhoid, as well as, you know, the usual chronic diseases. So, I was getting a lot of experience.

Tim:

Yeah.

Ann:

Everything was done in Spanish, so I had to be fluent in Spanish.

Tim:

And how many years was that?

Ann:

Yeah, four years.

Tim:

Okay.

Ann:

Then a group of people started a clinic and they would get some of the young professors, the young staff would come and we ran a little clinic and I ran the lab there too. So we saw a lot of cases in the community as well. And then after medical school I did what's called a fifth pathway.

Tim:

Okay.

Ann:

Which is if you train overseas, you came and did like, a pre-internship, you had to work in a US hospital. I did that at Long Beach Memorial, which was part of University of Irvine. So, we did pediatric intensive care, regular, we did clinics. They had a big, Hema- pediatric oncology unit there. And because I spoke Spanish better than anybody else, I remember one time I was in talking to a family about a little girl who'd gotten chemotherapy for, um, a leukemia. And so I talked to the family and I came back in and the father said, how did you learn to speak English so well?

Tim:

Which is the highest compliment.

Ann:

That's right. I said, oh, well, that's my native language. He said, no, no, you're Mexican. I said No, I only learned to speak Spanish in Mexico.

Tim:

Yeah.

Ann:

And during the time I was there, I'd go hang out in pathology in the labs, and they were having a series of lectures on parasitology from people at U C L A. Who came and taught for a week. And so I went to those and I said, where can I learn global health? They said, oh, well we have this course on Wednesday nights that's run by the UCLA School of Public Health.

Tim:

So at the time, was the concept of global health as a specialization, was it already there? I mean beyond charity.

Ann:

Yeah, it was more tropical medicine.

Tim:

Okay.

Ann:

So I asked them, you know, where can I learn? You know, clinical medicine and they said, well, we have a course it's free if you're not taking it for credit on Wednesday nights. So I drove up the freeway and started going to that. And one of the first people who lectured was Dr. Dan Connor. He was their visiting lecturer for that year. He came from the Armed Forces Institute of Pathology.

Tim:

Okay.

Ann:

He'd sort of written the Bible on tropical disease pathology. The old red books. I don't know if you know about them, cuz you're not an anatomic pathologist.

Tim:

No.

Ann:

But interestingly enough, in the 1960s, he'd spent three years at Kampala University in Uganda doing autopsies to find out what people in Africa were dying of.

Tim:

You know, it's interesting that you say that cuz in the course of my research for different projects, I realize now there were a bunch of these papers, the late sixties and and seventies, looking, just looking at the disease profile of different populations in Africa. A lot of the studies done in Uganda, whether it was heart disease or renal or whatever. So anyway, go on. Sorry. Go on.

Ann:

Yeah, so Dr. Connor did about 2,500 autopsies during that three years.

Tim:

Wow.

Ann:

And then he also worked on describing endo myocardial fibrosis and several other things that he described. And then after that, he traveled pretty extensively. And this is another sort of small world story. He and several people went to Kinshasa and then up to the Equateur Province to look at lymphatic filariasis. And one of the medical students that worked with him when he did that trip was somebody named Sambe Dwale.

Tim:

Okay.

Ann:

Who I eventually married, so, so, you know, the world is pretty small. Um, but anyhow, so he gave a talk, and he was a great lecturer and great photographer, and he gave this talk and I said, this is what I wanna do when I grow up. Travel. You understand anthropology, geography, you know, medicine and you help people.

Tim:

Exactly.

Ann:

So, I had that in mind. That was gonna be where I was headed. So then, I applied and did pathology at the VA Wadsworth, which was part of U C L A. Because I'd met people in the tropical medicine course. And so that's how I ended up coming up to do pathology, the UCLA VA program.

Tim:

Okay.

Ann:

One of the projects that I worked on with Dr. Voge, who was head of parasitology, was looking at stool samples of patients with gay related interpathy. This was in 1979. 80, early 19. Interesting. 80 interest. And so was at the VA and residency in the first years of when the first AIDS cases pneumocystis was being described, but also the, the adenopathy and the fevers that, AIDS related.

Tim:

Was it called like GRID? Gay related immunodeficiency, I think.

Ann:

Yeah. Yeah. So, the first case that a guy who came in and he said, oh God, I'm one sick queen. Then they did the CD four counts, and so they called it, SQUIDs was the first name, but that was sort of an internal, you know, sick queen immunodeficiency, and then it became gay related immunodeficiency because they were finding that the majority of the patients were from the gay community in the major cities. But then, people realized that there were people who had a similar syndrome in Africa. So about the time I came to the A F I P. Armed Forces Institute of Pathology, and department was infectious disease. I think it was maybe in 85, Tom Quinn came to talk about AIDS and he said, you know, we really need to send a pathologist over to Kinshasa to look at what's going on.

Tim:

And what was his role?

Ann:

It was the Washington Trop Med group, and they invited him to come and talk about H I V and AIDS in Africa.

Tim:

Okay. Okay.

Ann:

Then they found a job for me to go to the A F I P, and one of the things that they suggest that I do was go spend a few months working at the Mission Hospital in beginning of 86. I went to, um, Karawa in the Equateur province of Zaire.

Tim:

Wait, so, okay, let's step back a little. So, how did you get the opportunity to go there? Cause I think this is interesting for people who were considering getting into global health work. In the beginning, how did you afford it?

Ann:

I didn't get paid at all. I worked for six months and had enough money to come and train at the A F I P. And then I went back and worked in California for a while and I saved up some money and The church that I went to gave me a scholarship of$1,500 to pay the airfare. And when you go to a mission hospital, you know, they feed you and

Tim:

Yeah.

Ann:

Give you a place to live. I wasn't earning anything in the time I volunteered in Congo.

Tim:

Yeah. Yeah.

Ann:

Then when I came back, Dr. Connor and his family had me live there, and they gave me food and board until they could get me a paying job. So eventually I got a job at the A F I P and that was in 86.

Tim:

Okay.

Ann:

So, anyhow, during the time that I was volunteering in Africa, Tom Quinn had said, we need somebody to go to Africa and figure out what the pathology is. And then it was the A F I P who paid for me to go.

Tim:

Okay. Okay.

Ann:

They were interested in supporting an international project. And they'd done other things in the past supporting different international projects. So, that's how I ended up going out there and I was there for five years.

Tim:

Okay. Okay.

Ann:

When I volunteered and worked at the Mission Hospital, I was working in the northern part, in the Equateur Province, But when I went to Projet SIDA, we were in the capital city in Kinshasa. And because I was doing pathology, I was assigned to work at the university, but the main part of Projet SIDA was at the city hospital. Okay. Mama Yemo Hospital in downtown Kinshasa.

Tim:

So, at the time, what options did they have for treatment for HIV/AIDS? Or was it just almost like, Natural history studies.

Ann:

It was Natural History and serology had been developed by the time I got there. And actually Tom Quinn was the person who was doing the serology and the immunology. They were doing flow cytometry even then. They had really a lot of state-of-the-art stuff they were doing related to Projet SIDA. But a lot of it was big epi studies. There were studies with the blood bank. There were cell studies in factories, and then there were the clinical studies that were run. You know, the patients actually on the ward describing what are these patients dying of.

Tim:

Yeah.

Ann:

You know, and one of the things I said, I'm sure they're dying of tuberculosis and I'm sure there's gonna be H P V infection. So those were some of the things I looked at. And then I had to look at a lot of placentas cuz they were doing these big perinatal studies.

Tim:

Okay.

Ann:

The only treatment really available was opportunistic infections.

Tim:

Okay.

Ann:

And so they were treating US literature, pneumocystis not for TB.

Tim:

In Africa. Yeah.

Ann:

Yeah. And so we were saying, well, you have to treat for what they have. We did a lot of endoscopic work for causes of diarrhea. Then, it took a little while to get an autopsy suite that was, At BL2/ BL 3 level in order to do the autopsies. So, I did a hundred and something autopsies. The A F I P sent the equipment, and we set everything up, and we trained local people to work with me to do it.

Tim:

And when you were there, what was your relationship with the department at the university?

Ann:

I was sitting with them. I was sort of like visiting faculty or something.

Tim:

Yeah, yeah.

Ann:

So, I had my own little histology lab that we just used for HIV cases.

Tim:

Mm-hmm.

Ann:

And my office was in the Department of Microbiology, and these people had all been my husband's teachers.

Tim:

So Yeah.

Ann:

You know, I was part of the family. They considered me, as the wife of an African.

Tim:

So when did you guys get married?

Ann:

We got married in 87, so I'd been at Projet SIDA for about six months.

Tim:

Okay. Wow.

Ann:

I'd met him before.

Tim:

Oh, I see. You met him before, when you were volunteering with the Mission hospital.

Ann:

Yeah. So I came in September and we got married the following April. So anyhow, I was just barely outta residency. So it was a pretty exciting time and a steep learning curve. That sort of sealed my fate in doing global health. Well, HIV is what I did, but, a lot of tropical diseases are African diseases that were associated with HIV that I looked at first.

Tim:

Did you know at the time how long you would stay there?

Ann:

No. I would've stayed 10 years probably, but because the country fell apart and we all got evacuated out actually five years to the day of when I arrived, I got evacuated out. And that was in September of 91.

Tim:

Yeah. Yeah. So, what was your conception of what a career would look like in global health?

Ann:

Describing what diseases look like. What was going on with HIV, not from the basic science point, but what's happening immunologically, what does it look like in the tissue? So making that sort of interface. In 91 when we got evacuated out, Eric my son was two years old and Sambe was trying to figure out what he was gonna be doing. So I knew that I was gonna continue doing consult cases from overseas and maybe teaching or doing whatever. But I didn't imagine that I was gonna live overseas again for a while. But you know, at the time we were still getting a lot of cases from around the world.

Tim:

So, tell me a little more about the evacuation. How did that happen?

Ann:

In the beginning of September, my husband had actually been on a trip to, I dunno if it was Singapore, somewhere in Asia. And he came back to the airport and when he came home, he said something's gonna happen because he knew some friends in the security and they came and they escorted him and said, oh, it's so good you got home today, doctor, because we don't know what's gonna happen tomorrow. Things are falling apart. So go home and be safe. That was on Saturday night.

Tim:

Huh.

Ann:

Um. But there was several Ponzi schemes going around and money was being sucked up in the system. And so a lot of people were investing and there were a few people at the top that were getting all the money.

Tim:

Yeah.

Ann:

And military wasn't being paid and people were losing money. So, it was at the brink. And so then there were riots in the streets and people going around shooting and all that. So, the embassy just said, we're pulling everybody out.

Tim:

So, it wasn't like a coup or anything. It was more like society was breaking down.

Ann:

No, it broke down and Mobutu was sick at the time. And so things just fell apart. So, the embassy evacuated everybody out. So, my husband got back on a Saturday night. We were evacuated out on Thursday. Just Eric and I. Sambe came later because at the time he was head of the National Rural Health Program. And so he had a commitment to the government, so he stayed and came later after the first of the year. So anyhow, we got evacuated out. It was kind of traumatic, but eventually we got back and I came back to work the A F I P.

Tim:

How did you deal with your stuff? Like your slides-

Ann:

The embassy took care of all that, since I was under the US embassy, they took care of our stuff. They packed out the house. I went back the following April to pack out the stuff in the lab and bring back what I was gonna bring back.

Tim:

Okay.

Ann:

But a lot of stuff I just left with Professor Kalengayi.

Tim:

Okay.

Ann:

And during the time I was there, I would send or bring back, the stuff we were working up at the A F I P, so a set of slides and blocks and stuff were already being sent back to the A F I P for study.

Tim:

Okay. So it wasn't too disruptive. Well, you were able to keep your material, your slides, and your blocks.

Ann:

Yeah, most of the material. Yeah. I mean, a lot of studies weren't completed, but yeah, we left with a lot of the things that we'd collected. So it wasn't a total loss. I mean, some things were stolen during the looting.

Tim:

Right.

Ann:

But not from my lab, from some of the people that I was collaborating with. And that was more the clinical part of the records, not my slides or blocks. Yeah. So anyhow, so I guess that's where we'll-

Tim:

Yeah, we'll stop there This is, this is cool. This is great. And then we'll stop there. Actually, I told you this would be two episodes.

Ann:

My post- projet SIDA life. Yeah. Yeah. Be the next call.

Tim:

Yeah. Yeah, exactly. Our guest today is Dr. Ann Nelson. Thank you for listening to the Lab Voices podcast. I am your host, Tim Amukele. To find out more about Pathologists Overseas and our projects, visit www.pathologistsoverseas.com and follow us on social media. Podcast edited and produced by Taylor Harris. Theme music by Tim Amukele.