Balancing a Career in Global Health with Shannon Galvin, MD

• While originally pursuing a career in marine biology as a college student, Galvin ultimately chose to study infectious diseases, not only to hopefully make a more immediate impact but also because she loved the puzzle of diagnostics.
• While at the University of North Carolina, Chapel Hill, Galvin was offered the position of chief resident, but she turned it down for the chance to pursue global health work in Malawi.
• For a year in Malawi, Galvin worked at the Lilongwe Central Hospital and the Lighthouse HIV Clinic doing research in CD8 T-cell responses in HIV-exposed persons.
• As a faculty member at UNC, Chapel Hill, Dr. Galvin worked with clinical NGOs, especially PEPFAR or USAID-funded projects, to increase HIV care in low-resource countries. This led to continued work in Malawi and additional work in Rwanda, Ethiopia and Sudan. 
• Galvin shares the many ways she balanced her professional ambitions abroad with raising a son with her husband, Dr. Susheel Reddy, a clinical researcher and biostatistician.
• While still a clinician, Galvin grew her global health research portfolio during her years at UNC by joining projects funded by the HIV Prevention Trials Network and by the HIV Vaccine Trial Network, led by UNC faculty. 
• In 2008, Dr. Galvin moved to Chicago to be closer to family and joined the faculty at Northwestern, where she has led and supported research projects in HIV care, antiretroviral treatment, rapid diagnostics, and models of clinical care in resource-limited settings, including in Chicago.
• Galvin says Northwestern University can contribute to the global health solution by working with clinical partners to support their needs (whether funding, technical support, data analytics, etc.) and by harnessing the university’s greatest asset, which is the human capital of its trainees.
• For aspiring global health professionals, Galvin says that perseverance is one of the most necessary qualities to pursue. She also says that sometimes it is better to learn from other people’s mistakes rather than following explicit advice, which may or may not be helpful in the long run. 

[00:00:00] Dr. Rob Murphy: Welcome to the Explore Global Health Podcast. I'm Dr. Rob Murphy, executive director of the Havey Institute for Global Health here at Northwestern University Feinberg School of Medicine. My guest today, Dr. Shannon Galvin, is an infectious disease specialist and HIV researcher at Northwestern Medicine whose work has touched the lives of many people in Malawi, Nigeria, Mali, Ethiopia, Sudan, India, and right here in Chicago. At The Havey Institute for Global Health, Dr. Galvin is the Director of Global Clinical Outreach, a position she just obtained. She's also the Associate Director for the Center of Global Health Education. And at the university, she's an associate professor of medicine in the Division of Infectious Diseases. We welcome her to the podcast today to talk about her career path and her current work, developing productive and sustainable clinical projects in global health. Welcome, Shannon.

[00:01:07] Dr. Shannon Galvin: Thank you. 

[00:01:08] Dr. Rob Murphy: Let's start at the beginning. I understand you grew up in Florida and your mom was a social worker and your dad an engineer. What was life like for you as a child in the Sunshine State? Was there anything in your childhood that would have foreshadowed your career in medicine and in global health?

[00:01:25] Dr. Shannon Galvin: I would say two things of note. The first is that, as you mentioned, I had two wonderful parents and I have two younger sisters who are some of the most amazing people I've ever met. And I got all that when I was born. I was born in a safe place with parents who loved me. I had enough to eat , I had a stable housing over my head as a child, so I think that just meant that I needed to do a lot of work to give back all that I received. I had never anticipated becoming a physician. No one in my family was a physician. I picked that career because I was interested in science, but I also wanted to do something where I made a difference. I used to say like, Oh, I hope I have a job where it matters if I go to work every day. And now sometimes I curse that I chose something where it matters that I go to work every day 'cause it is challenging, but yeah, I literally just kind of through deductive reasoning came upon being a physician through those kind of two categories.

[00:02:25] Dr. Rob Murphy: You graduated from Florida State University with a major in biology and minors in chemistry and statistics, and then you went on to medical school at the University of Miami School of Medicine. At this time, you had already started on a path in infectious diseases. What drew you to that field?

[00:02:42] Dr. Shannon Galvin: Well, initially I was gonna be a marine biologist. That's what I went to college to study. And I wrote my honors thesis, one of them on cetacean evolution. But yeah, I kind of pivoted wanting to work more with people in a field that I thought maybe had more immediate impact. And then again, when I started medical school, I anticipated becoming an oncologist but what drew me to infectious diseases was that I really like the puzzle piece of medicine. I like figuring out what somebody has. I like problem solving. I like diagnostic challenges, but I also like working with people both in the short and long term. I like working with people who are very sick in the hospital, but also getting to know people and being their doc for years and years. So infectious disease was kind of the perfect combination of something where you get called to see a lot of interesting cases, not always even infections. You get to make diagnoses that usually can help somebody, and in the case of HIV, save their life. So it checked all those boxes, and I've never regretted my choice.

[00:03:49] Dr. Rob Murphy: Were you able to partake in any global health endeavors during your undergraduate or medical school years?

[00:03:54] Dr. Shannon Galvin: Short answer is no, not at all. I didn't go anywhere. I didn't do anything international. I was working in college. I had to, you know, I worked waiting tables to support myself. So I didn't have a lot of extra time to travel. And then it just wasn't anything I'd been exposed to about working traveling overseas. It wasn't until after I'd finished my residency. That was the first time I ever left the country was when I moved to Malawi for a year. I didn't even have a passport until then. 

[00:04:22] Dr. Rob Murphy: So you moved on to internal medicine at the University of North Carolina, Chapel Hill. And you also did your fellowship training in infectious diseases there. And I understand, and this gets back to what you just said, that you were originally named to be chief resident, but you deferred that position to go to Malawi. Can you describe how you veered off in the global direction at that point?

[00:04:45] Dr. Shannon Galvin: Yes. I think maybe one of many steps in my career that probably somebody, if I'd asked for advice, somebody maybe would've advised me to do something different. But when I was finishing my residency and I was, I had this year because I was, had possibly had been offered a chief position, but I reconsidered that because I wanted to spend time exploring what were the other ways that one could take care of patients. And so, you know, I was familiar with how it worked in a hospital. But I really wanted to explore working in a resource limited setting, and I found this opportunity. I was lucky to have this opportunity through UNC, through the Division of Infectious Disease that's there, where I was gonna do my fellowship to work with UNC Project Lilongwe. So I made a choice that I was gonna try something different rather than kind of continue on the same career path.

[00:05:38] Dr. Rob Murphy: For about a year during this clinical postdoctoral fellowship at the UNC Project Lilongwe, you worked at the Lilongwe Central Hospital and the Lighthouse HIV Clinic doing research in CD8 T cell responses in HIV exposed persons. Can you tell me how you veered into that Research direction, specifically, and the laboratory component of it, and here you are in Lilongwe?

[00:06:04] Dr. Shannon Galvin: Yes, I was advised by somebody you know well, so Charlie van der Horst, I was going to go overseas. I, you know, had been trained as a physician. I was clinically minded. And he was like, Hey, you can't just go there. You should get do some research too. So I was like, Oh, okay, let me investigate. And Mike Cohen, who was the division chief at that time, arranged for me to work on a project with Jeff Frelinger, who is an immunologist. We are investigating CD8 T-Cell responses. And I had an idea that maybe we could look at persons who might have been exposed to HIV. And at that time, now that I'm in Malawi, I worked in the STD clinic where there were a number of research projects that were ongoing that investigated STDs in the role in HIV transmission. Working in the clinic was very eye-opening because the HIV prevalence was 50%. So someone would walk in, like, half the people have HIV, half the people didn't. And it was just interesting to think, was it just luck? What led to somebody contracting HIV or the next person didn't? And so that led to my interest around correlates a protection. And, like a brief foray into doing immunology work, which I still find fascinating. I know at some point you ended up in South Sudan, I believe. And you were there for, I think, at least six months. How did you get from Malawi to Sudan?

[00:07:28] Dr. Shannon Galvin: So after I finished my fellowship, I joined the faculty at UNC. So for a number of years, I was initially lived in Malawi, was based there, did clinical work there, kind of worked on projects, research projects with UNC. And at that time, it was a Lilongwe Central Hospital and the Malawian government joint projects that were already ongoing. But then when I transitioned to a new phase as a faculty member, I was based back in Chapel Hill. And then part of my funding, part of my salary came from working with clinical NGOs, including in organization called InterHealth, and then other partners that were doing clinical work, especially around PEPFAR funded or USAID funded work that was at that time going on to increase the ability of countries to provide HIV care. So, as part of my job, I would work with different organizations that had usually US government funding that were working with these US based organizations to set up their different projects. And so, that's how I was fortunate enough to work in Rwanda and Ethiopia with governments there that had funding from the US government to work on, say, prevention and maternal child transmission our initiation of antiretroviral therapy. And at that time, it was Southern Sudan, so it hadn't officially broken away from Sudan, And they also had a project where they were working with the SPLA, the Sudanese People's Liberation Army, to set up treatment centers. And so they needed an infectious disease physician to work with a team kind of designing protocols around HIV treatment initiation, 'cause that would be a relatively new service that they were gonna be able to provide the people living in South Sudan. 

[00:09:12] Dr. Rob Murphy: I want to switch gears a little bit and ask you a personal question, if I may. You're married to Susheel Reddy, a clinical researcher and biostatistician who's here at Northwestern who is also a professional collaborator of yours. At what point in time did you two meet? How did you meet? And what sort of connection do you share when it comes to global health and traveling to countries outside the U. S.?

[00:09:36] Dr. Shannon Galvin: Susheel and I met in medical school. He is one of those extremely bright people. He went to medical school on a six year program. He then went on to actually do a degree in biostatistics. And he is an absolutely wonderful person. Whenever I question the decisions I've made in my life or the talents I have, I just reassure myself that I chose such a smart, kind, wonderful person as my spouse and congratulate myself on that awesome choice. So kind of during my journey for global health, I had various iterations of how you kind of have a family and work in a setting that isn't your home country or your birth country. For a while I lived overseas but my husband didn't live with me. Then I would spend long periods of time and then be away from my husband. And then I had my son and actually initially for the first couple years, I still was traveling maybe 50 percent of the time, which is a lot with a young child. And then I kind of realized that maybe for me personally and for my son and my husband, it maybe wasn't sustainable. So kind of transitioned again to doing a new role where I didn't have to travel as much. I do wanna reflect on before I had my son and I was thinking about what it would be like to be a mother just in general, but also a working mother and then maybe somebody who travels a lot for her job. I was working still in Malawi and my friend who is a Malawian, her young son got very ill and we had to take him to the hospital in the middle of the night. And so there was a queue of parents with their sick children just kind of sitting in the hallway waiting to be seen. And my friend she looked at me and she said, being a mother is terrible. And just that fear that she would lose her son and anyone who's a parent kind of knows that fear. But also later, I often think back about like, parents, the other parents who are there. And it's one of the mental pictures I keep most close in my mind when I'm trying to think of like, am I doing something useful? Is anything I'm doing making it so there's just less parents sitting in a dark hallway hoping that their child makes it through the night? And also for the clinicians, you know, think of how brave you have to be to show up night after night, taking care of sick children with not very many resources. So is there anything I'm doing that helps clinicians in that situation do their job better 

[00:12:12] Dr. Rob Murphy: This is really great insight for many people listening to this podcast because ultimately many people, going into global health. They're worried about this impact of travel and what happens with the other relationships. So it's really illuminating to hear your story and how you got through it and how you actually sort of changed your career path to accommodate your family as well.

[00:12:35] Dr. Shannon Galvin: There's probably no right way, just like there's no right way to raise a child in general, but there's always a way. And then, you just keep assessing, like, is this working? Is this working for my family? I know that there's other ways other spouses have done it. Sometimes it's a time-based model, like I'll focus on my career and then you have time to focus on your career. Sometimes it's more just like your life, you know, you divvy up parts of your life so that everyone can continue to be productive, but still take care of your family. So there's no right or wrong way and it'll always be a challenge. But it is a challenge that you can usually find a way to overcome. And I have the advantage of living a now a relatively long life, and I can say that whatever time of life you're in now, it'll change, and your circumstances will change. Nothing's forever. So that can be good and bad.

[00:13:28] Dr. Rob Murphy: Let's go back to your career journey. You transitioned from a faculty position at UNC after your fellowship there. How were you able to grow your global health research portfolio during your years at UNC? Can you give us just a quick overview of the projects? You've sort of mentioned them along the way, but you know, how did your progress once you moved in that direction?

[00:13:50] Dr. Shannon Galvin: I had a mix of activities at UNC. As I mentioned, I was actually partially funded through programmatic work, so I literally did clinical work through funding through USAID and PEPFAR funding to kind of develop clinical programs. I still was a clinician. I attended on the wards. I had a clinic. And then I had smaller projects on my own, but also was able to tap into larger research projects that the division at that time had including projects funded by the HIV Prevention Trials Network, by the HIV Vaccine Trial Network that the faculty there at UNC led. And I, as like a junior faculty, could participate on. I think that was kind of a good model at a place that had a variety of options to jump in and then also try to do it on your own as well. So that's kind of how I had a breadth of activities there. I was often given the advice that you need to focus, and I think that is actually good advice for young people, especially young people in academic medicine. It is one of the many pieces of advice that I didn't take. I think that is a way to be successful but at the same time, there's a Venn diagram of what it takes to be successful and what it takes to be useful and what it takes to be happy. And so sometimes you just gotta find that place in the middle where most of the things meet, realizing, yeah, you're leaving out maybe a little bit of each aspect of your life including the parts that would maybe make you the most successful you could be. But if you feel more useful and more happy, you have to take that trade off and then you have to be an adult about it and accept that you made that choice and you took that trade off and accept the consequences of it.

[00:15:34] Dr. Rob Murphy: In 2008, you came here to Northwestern University. What drew you to Northwestern University in Chicago?

[00:15:42] Dr. Shannon Galvin: So this was around the time after I had my son. So to be frank, this was kind of when I was looking for a change, one where I wouldn't have to be overseas as much. But then honestly, it was also a family related decision. My husband's parents live here and we wanted to be closer to family and made a decision to relocate to Chicago because of that. So, I was really lucky to land at Northwestern, which is a great institution. I looked at other places, but I was excited to come to a place that also was doing global health work kind of in a slightly different way than UNC had been doing it. and also had a really great division of infectious diseases. So I just kind of lucked into it, honestly.

[00:16:25] Dr. Rob Murphy: Over the last 15 years here at Northwestern, you've continued to lead and support research projects in HIV care and antiretroviral treatment, rapid diagnostics, models of clinical care in resource limited settings, including right here in Chicago. Let's talk about your Chicago based work. You're an investigator for the Chicago AIDS Clinical Trials Unit. And are part of the Northwestern HIV Rapid Response Team. Tell me about those and any other projects you have here and how your global health background helps you with this work.

[00:16:57] Dr. Shannon Galvin: So at Northwestern, I've continued really to have a relatively diverse portfolio for an academic investigator. I do a lot of clinical work. As you say, I'm the medical director for the ID Center and I have some research funding for both investigator projects that I do, but also through the AIDS Clinical Trial Unit here led by Dr. Babafemi Taiwo, and then do a lot of educational work along with my colleagues Bill Leonard and Ashti Doobay-Persaud at the Center for Global Health Education and all the wonderful folks we get to work with. So, have a kind of an education, research, and clinical portfolio. Working in global health, is working to address inequities. And sometimes those inequities are knowledge based gaps, sometimes those are resource based gaps, sometimes it's just kind of the know- do gap, like we just know what we should be doing, but we're just not doing it. And so a lot of the projects I've worked on that are Chicago based still reflect that interest. And like, just how can we just do this better? Especially here at Northwestern. We're blessed with so many resources. How can we use those resources more effectively? So I run the HIV rapid diagnosis service here at Northwestern Medicine.The goal is that, as you know, in HIV care, we've come so far and really we are looking to kind of improve that cascade to care. So from, people who don't know they have HIV to those folks getting diagnosed, to those folks being linked to care, and now the standard of care is kind of like 24 hours linkage and immediate ART initiation. And then keeping people who have been started on ART in care and undetectable. So, a lot of work is making sure we're screening the people we need to screen, so working with acute care settings where people might come who don't have like a PCP, to offer them HIV testing. If they test positive, that becomes my job, you know, as an ID doctor, I need to be the one to step in 24-7. That's not the ED's job, that's nobody else's job but mine to kind of chat with that person, make sure they have their questions answered. It's actually this particular aspect of my job is one of the more rewarding parts. You meet somebody, they're a complete stranger to you. They've just been told, or you have just told them that they have HIV, which is still a disease with a lot of stigma and untreated is fatal. But you can say, literally, I can guarantee I can treat you. I have a medicine that if you can take this medicine, your life expectancy will be the same as pretty close to somebody who doesn't have HIV. And so in medicine, there's not too many things that are as rewarding, to be honest. So that gets me up in the middle of the night. It makes me change my schedule if I need to accommodate a patient. It makes me do anything that I can do to help people who are starting on a very terrifying journey, but one I know that they can be successful on. And so those are the kind of things that I get to do here, but that's what a lot of global health work is too, is that some of these problems have solutions, and it's just getting solutions to the people who need them.

[00:20:12] Dr. Rob Murphy: You're also the principal investigator on a project examining best strategies in HIV and hepatitis C testing and linkage to care, Project NOMO, No Missed Opportunities. Can you tell us a little bit more about this project? 

[00:20:26] Dr. Shannon Galvin: This project was one where we were looking at, similarly to the HIV Cascade to Care, kind of looking internally at our Hepatitis C Cascade to Care. It is a condition that is one of the leading contributors to death and morbidity, at least nationally. But is completely curable, but most people don't know they have it. So the first step is making sure we're offering screening tests, hepatitis C testing to people, and then linking them to care. So, the project it was really more a kind of implementation improvement science type project where we kind of just said, where are the opportunities to increase screening for hepatitis C in our system? What are we doing with those people who test positive? What's kind of the outcome? The kind of sad news is, initially, like, the cascade for hepatitis C is actually way less successful than for HIV. We link 99 of people with HIV at Northwestern, at least to initial care. But hepatitis C, it's more around 60 ish percent. And a lot of the barriers are kind of related to the comorbidities associated with hepatitis C diagnosis in the U.S., which includes substance use disorder, which as a medical system everywhere, we're not unique, can kind of struggle to offer people good resources that can kind of help them, use those resources and then also get care for their hepatitis C. So, the project just looked at where can we improve screening and then for screening, what are we doing about linkage, including linking them to hepatology and ID docs. And then once they get linked, that's the easy part. The treatment is available. There's a slightly not easy part about getting the treatment covered, but we're doing better with that. But once we can get the treatment to the patients, we can be quite successful for patients. So it's really the intermediate steps of the cascade where we still need to look for better opportunities.

[00:22:18] Dr. Rob Murphy: You've helped expand opportunities for Northwestern students through our Center for Global Health Education. Over 50 percent of our medical students actually take advantage of this particular program to have some international global experience. What are your goals in this current chapter of your career with these projects?

[00:22:36] Dr. Shannon Galvin: I think my goals mainly focus on asking the question or continuing to ask the question of how a US academic medical center can be part of the solution. Sometimes this is true for people and individuals and institutions, too. Actually, before you try to be part of the solution, you need to ask yourself, are you part of the problem? And usually we're somehow part of the problem, and it's just figuring out what part of the problem you need to do less of. So that's my goal, and like I've mentioned before, we're so fortunate to work in such a great institution that has so many resources, so asking how can a place like Northwestern or how can other US academic medical centers be part of the global health solution, and I would say that's twofold. The first part is working with clinical partners to understand their needs. This is where someone like me who has a breadth of experience can be somewhat helpful. Some of our partners engaging in scientific research, very advanced scientific research, and just need linkage to support to do that, whether it's just funding or technical support. But many of our partners are primarily clinical, and they need access to resources too. A lot of that can just be access to funds. Or to other things such as data analytics or grant writing resources, things that clinical organizations need to kind of advance their work. And it may be partners who actually need clinicians. There is still a gap of the number of healthcare workers in the world and where they are located relative to the need. But for those clinicians, they have to be the right providers with the right skills at the right time, and they have to be able to be delivered to our partners in a foreseeable and sustainable manner. So that's the first aspect, kind of working with clinical partners to understand their needs. The second aspect is harnessing the biggest asset that a university has, which is human capital, and especially the human capital of its trainees. That means thinking of ways to harness the intellect and energies of young people in a way that also contributes to the solution and not to the problem. So things like our program, Access to Health, where I work with my colleague in the law school, Julia Sorenson, where law, business, public health, and medical students do focused project work only at the request of a partner, as part of their training and coursework. Another example is our MSGH program where we work to provide nonclinical technical skills, such as grant writing, data analysis, logistics, probably most importantly, communication and listening skills that global health professionals would need to be value added to their partners. So that's kind of the second aspect, harnessing the human capital of a university for good.

[00:25:33] Dr. Rob Murphy: One final question, Shannon. What advice do you have for young people who are just now embarking or wanting to embark on a career in global health?

[00:25:43] Dr. Shannon Galvin: I really feel the attribute that you need the most is perseverance. Not to give up, you're gonna make mistakes, just be humble about that fact and keep going. So, I try to have perseverance. It is kind of my touchstone for myself and for anybody who's working in this career. And then the second answer to your question is advice I give is not to listen to anyone's advice. Advice you get is really bad. But the gift that people can give you is a gift of their mistakes. That kind of hopefully will allow you to not make the same ones and learn from that, rather than all of us having to learn the hard way ourselves.

[00:26:22] Dr. Rob Murphy: Well, Shannon, thank you very much for taking us through your remarkable career path. and, good luck in the next chapter of your career.

[00:26:30] Dr. Shannon Galvin: Thank you, Rob. 

[00:26:31] Dr. Rob Murphy: Follow us on Apple Podcasts or wherever you listen to podcasts, to hear the latest episodes and join our community that is dedicated to making a lasting positive impact on global health.