Carving a Niche in Global Health with Satish Gopal, MD, MPH

• “Home” is an expansive concept to Gopal. His parents immigrated to the U.S. from India and he visited the country often. He was raised and educated in the U.S., yet spent his early-to-mid adulthood with his young family in Africa. “I think many people navigating the world today don't have a unidimensional idea about what home is,” he says. 

• Gopal’s global perspective started as a child, on trips to visit family in India where he encountered people living in shanty towns near his family member's middle class neighborhoods. Those experiences made him very conscious of the more fortunate circumstances he was born into and he entered medical school with the hope of improving the lives of others. 
• After a few positive rotational global health experiences in medical school and residency, Gopal and his wife, who had been a Peace Corps volunteer in Benin, decided to go to Tanzania and live and work for a couple of years along with their six month old and found that global health work was a viable long term trajectory.
• He says if you're in a family, it is important for all partners to be “all in” on the experience because inevitably challenges will arise. For example, his youngest daughter had cerebral malaria while they were in Malawi. 
• Gopal went on to do more training at the University of North Carolina (UNC), which has a long-standing clinical research program focused largely on HIV in Malawi. He saw an opportunity to develop and expand the portfolio there to address cancers, many of which are HIV associated.
• In 2012, through initial seed funding through the Fogarty Fellowship program, through the NCI, Gopal was able to establish a UNC faculty position based in Malawi and focus on cancer research. 
• He says at that time no one was writing grants about the problem of cancer in Africa and he saw this as an opportunity as an early career scientist to make an impact in the field. 
• Through relatively simple studies he wawa able to learn a lot about  cancer in Africa and attract collaborators all around the world as well as a pipeline of young talent from both the U.S. and Africa. He also successfully competed for funding to sustain those interests in that group and those lines of inquiry over time. 
• The opportunity came to apply for the Director of the Center for Global Health at the National Cancer Institute and Gopal said it was the right next step in his career. 
• In his new role, he is using what he had learned in Malawi and leveraging the platform, experience and resources of the NCI to have as much impact in the places like the clinic where he used to work in Malawi. 
• He is actively engaged in President Biden’s reignited the Cancer Moonshot project with the goal of “Ending Cancer as We Know It Everywhere.”
• Gopal’s advice to young people interested in global health is not to “dabble” in it indefinitely. He believes global health is a discipline and not a hobby and it requires commitment.

Rob Murphy, MD [00:00:05]   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. Today's guest, Dr. Satish Gopal, wants to make cancer a global health priority and end cancer as we know it everywhere. And he's doing it from a very influential position. He's currently the director of the Center for Global Health at the National Cancer Institute, the NCI, a role he took in 2020. Dr. Gopal joins us today to talk about his career path to the NCI and his insights from years of leading a cancer program in Malawi where he lived with his wife and two young children. Welcome, Satish. 

Satish Gopal, MD, MPH [00:00:49] Thanks so much for having me. Rob, it's really great to be with you today and I really appreciate the invitation. 

Rob Murphy, MD [00:00:53] Where do you call home? You grew up in North Carolina. You received your bachelor's degree from USC Chapel Hill, medical degree from Duke and completed your residency. Training in internal medicine impedes at the University of Michigan. Then you went to Malawi, which will always be a special place for you and your family because it was such an important part of the formative period in your lives. 

Satish Gopal, MD, MPH [00:01:14] Where do I call home that such a complex question. Currently, it's Bethesda, Maryland, since I work at the NCI, but my parents immigrated to the U.S. from India. I grew up the first generation children in the United States. I married a white American and we ended up spending most of our young adulthood and our early life as a family together, living and working in Africa and are now back in the U.S. So I think it's difficult to say exactly where home is, but I actually think home is a pretty expansive concept to me. And I think many people navigating the world today don't have a unidimensional idea about what home is. So I don't think our particular experience is actually all that unusual. And actually much of what we struggle with now is trying to put people's complex identities into fairly narrow boxes in a way that probably doesn't do justice to individual experiences. 

Rob Murphy, MD [00:02:06] Things have really changed so dramatically since I was in your position. Career-wise, very few people really traveled abroad. If they traveled abroad, they maybe had gone to Europe or, you know, maybe a trip to Asia, but it was not a lot of experience in that respect. And now what we're seeing is people have traveled so much everywhere around the world, and they come pretty experienced in the whole travel process. But the one thing that hasn't happened so much is how you get your career footing into the global health sphere. If you could just elaborate a little bit on your training. Where did that come from? How did it start? 

Satish Gopal, MD, MPH [00:02:47] My interest definitely started in childhood. We traveled to India when I was young. My family was kind of middle class. But the nature of Indian cities is to often have more middle class neighborhoods quite close geographically to shantytowns or much less well-resourced residential neighborhoods in areas. So I remember walking from my relatives houses, even going for a short walk down the street, you would naturally encounter people who looked just like me, but lived in very different circumstances. So I definitely had that awareness from a very early age, and I was very conscious also of the fact that the things and opportunities I had had really nothing to do with me. They really had to do with the fact that my parents had chosen to emigrate and had made a life for themselves in the U.S. So that global understanding, I think was a natural byproduct of just the way that I was raised. When I went into medicine I think that continued to inform a lot of my thinking. I think most medical students probably write that they want to go into medicine to make the world better. And I certainly wrote something along those lines and meant it and was always interested in how a career in medicine and biomedical research might allow me to work and potentially have impact in places around the world. 

Rob Murphy, MD [00:04:00] How did you end up in Malawi for five years and how did you end up with your entire family? And that's a pretty unusual arrangement. 

Satish Gopal, MD, MPH [00:04:08] I was interested in medicine, was interested in biomedical research, had, I would say, fairly vague ideas about wanting to have a global health career but didn't have either established paths or terrific role models who I could see doing exactly what I wanted to do. So I had a few rotational experiences in medical school and residency. These are commonly offered where you can go for a month to a place that your institution has a relationship with. So I took advantage of those when I finished residency and could practice as an independent physician. My wife, who also had strong global interests and had been a previously a Peace Corps volunteer in Benin, we decided we should just try this together and see if it's something that we like and see if it's something that we may want to do, not just as an experience but as a career. And so we had an opportunity actually to go first to Tanzania and live and work there for a couple of years. We went with our six month old daughter at the time, and that was really just to test out whether this was a viable long term trajectory for us or not and whether we could imagine building a life together along those lines. And we had an amazing experience, really recommitted ourselves to that as a path. It was actually while living in Tanzania that I became  interested in cancer. So then I came back to the U.S., did a little bit more training at the University of North Carolina, which, as you know, happened to have a long standing clinical research program focused largely on HIV in Malawi, in Lilongwe specifically. And so when I finished my training there, there was an opportunity to go and work at the established site, but trying to develop and expand the portfolio to address cancers, many of which are HIV associated and Malawi and other African context. So the opportunity to use that as a base to then grow a real new direction for the program was really exciting for me, especially as a young faculty member by that point had a second daughter. So my wife and I and our two daughters at this point moved to Malawi, where we were then for seven years from 2012 to 2019. 

Rob Murphy, MD [00:06:02] Any suggestions on getting your family engaged with you in this global experience? 

Satish Gopal, MD, MPH [00:06:09] One, it can work. It works really well for us and we loved it and we honestly miss it. There are many days where we think to ourselves, Gosh, that we loved it so much in Malawi. So it definitely can work. I think it's important if you're in a family for all partners to kind of be in it. If it's a situation where one person is dragging the others because of their interest and the others aren't committed, that isn't likely to work because there are inevitably challenges. I mean, my youngest daughter had cerebral malaria while we were in Malawi. Things come up. I think it's important for everyone to be committed and know why you've decided to make that choice as a family. That may not work out for everyone, but I think for those for whom it can work, we just had a life changing experience, right? I mean, all of our formative years as a young family were spent in Africa. My daughters have spent more than half their lives there. They have friends from all over the world. It's just been so deeply, professionally and personally enriching for all of us in ways that I think we can barely begin to articulate half the time. So it's a wonderful, wonderful experience. It's such an opportunity to learn and enrich oneself. But I do think it's important for everyone to be committed to it. I think it's very hard to make it work otherwise. You know, oftentimes you're trying to create a job that doesn't really exist. You have to deal with a lot of infrastructure and or health related challenges from time to time and if you don't really know why you're there, that can be hard. That can be hard to get through those periods. 

Rob Murphy, MD [00:07:33] I've been to your site there. You hosted NIH extramural researchers. That UNC program there is just terrific. One thing you mentioned is this one month rotation that you had as a student. There's a lot of discussion about medical students rotating abroad, especially in low and middle income countries. And we promote a lot of it. We send our students pretty much almost everybody gets a small scholarship to cover some of the costs of those, and we vet the different places that they go to, so we make sure they have a good experience. How important do you think that one month rotation is? Should we continue to be encouraging these experiences? Do you have any suggestions? 

Satish Gopal, MD, MPH [00:08:16] I don't think that they should be canceled, but it's important to think about how these kinds of experiences go forward. There are people like me who needed those early experiences just to feel comfortable committing to a longer trajectory. So I don't think that they are worthless in any way. And I think similarly people from LMICs coming in, having one and two month experiences at institutions in the U.S. can also be extremely valuable. But I think we should take them for what they are. They work best when they're couched in a strong institutional partnership with adequate mentorship. Right? I think people need to be honest about what the nature of these experiences are, what the likely contribution is going to be, what the resource asks on the hosting institution are in the low and middle income country. There's a lot of that kind of discussion going on as we re contemplate global health equity against this larger backdrop of social justice renewal that has occurred over the last few years. So I think these conversations must happen, are right to happen, but I don't think that means that all such experiences are valueless either. 

Rob Murphy, MD [00:09:20] We're continuing along that way and we're doing basically exactly what you just said. We're building up the mentorship on both sides. We're sticking with known partners and reevaluating the process as we go along. And I think we've come to a pretty good place. I also think that first trip, if you're going to get that spark going, if you can see the potential, particularly for the career choice, you make a career in global health that's very different than staying and doing a residency, being in a practice, a university practice or private practice or whatever you're going into. It's a very different paths. 

Satish Gopal, MD, MPH [00:09:55] I would say two things. It's critically important that the hosting LMIC see institutions get the support and recognition that they deserve for hosting these educational experiences really out of their own generosity when they're facing many other competing needs. But secondly, I agree. I've always believed that global health is a discipline rather than a hobby in other disciplines like genomics, it's very common to spend a month or two as a medical student or even an undergraduate in a lab over the summer, and you get a sense that of what this field is about. Who are the people who are working in it? Is this a path that I can see for myself? And then you slowly build up that commitment, acquire the training and expertise that's needed. I don't think of global health as really any different. And I actually think one of the difficulties that we've had historically is we often approach global health as a hobby rather than a discipline. I think if we bring to it a little bit more humility and a little bit more of a long view rather than this undergrad needs a one month experience in Africa to help build their CV for a career that's going to go in a very different direction. That, of course, I think has much less utility and is frankly extractive in relation to our LMIC partners because they're being asked to take on a burden that doesn't directly benefit them in a meaningful way. 

Rob Murphy, MD [00:11:09] In 2012 or so, you were a Fogarty fellow. Tell us a little bit about that whole experience and how that impacted ultimately your career choice or pathway? 

Satish Gopal, MD, MPH [00:11:18] I was a Fogarty fellow in 2012, which provided the initial seed funding, actually convinced my institution to offer me an unprecedented faculty position. Someone at the cancer center trained in oncology and infectious disease who was going to be based halfway around the world and see hundreds, if not thousands of patients, but generate no clinical revenue doing that. There wasn't exactly a model for that when I started in 2012, and that seed funding was incredibly important. The Fogarty Fellows program is having its 20th anniversary this year in April, and there's a big event planned and actually Roger Glass always says that I was one of the first fellows who was interested in cancer, and he asked me to write the foreword to the book that is accompanying this 20th anniversary celebration that features so many of the fellows that have had such successful careers, which was a real honor. It's also been really nice then once I was established to host a whole series of subsequent fellows who really were interested in cancer, came and worked with us in Malawi, had an immersive experience, typically over a year or two, and then went on to global health careers, academic careers based either in the U.S. or at various African institutions. So I think that initial demonstration of interest from the NIH and even modest investment from the NIH, as you know, is so important to signal to institutions that this is something that the NIH cares about, is willing to support, and that often enables things that just wouldn't happen otherwise, like the creation of new faculty positions that don't kind of fit the conventional model at a cancer center or global health institute or academic institution. 

Rob Murphy, MD [00:12:50] We've had one of those Fogarty fellow grants for a while now. The people that do it, the colloquial way of saying has come back changed. I think that one year abroad is the thing that really is the most impactful. Everybody has continued on with the significant global health portfolio and they're starting their career. 

Satish Gopal, MD, MPH [00:13:12] Even if someone were to only work domestically, they would still do that work with a completely different lens, right? It's so eye opening just to see the talent that exists in other places, the different ways of approaching a problem that occurs in other places, the similar challenges that are faced in societies all around the world. You know, these are just educational experiences as people, not just as scientists or clinicians. And I think even if you were subsequently to work only domestically as some proportion of Fogarty fellows, do you still approach that domestic work I think with a very different mindset. 

Rob Murphy, MD [00:13:45] Can you tell us just a little bit about the UNC project Malawi, how you were able to take that thing and really grow it? 

Satish Gopal, MD, MPH [00:13:53] The project, as you know, existed from the 1990. Is there a lot of these US academic partnerships focused on HIV that originate from that early period in the HIV epidemic when there was a really important international Aid Society meeting that was held in South Africa in Durban, I believe, where there was broad international recognition of what a big problem this was, the research that needed to be done to really meaningfully inform how this would get addressed in the part of the world that was most severely affected. And so there are a lot of academic programs focused on HIV that date to that period. And UNC has a strong HIV clinical research program and established connections in Malawi and started to establish some infrastructure there to do meaningful HIV related work. Much of that occurring through the NIH supported HIV networks that came into being from our sister institute, the National Institute for Allergy and Infectious Diseases, the AIDS Clinical Trials Group. All of these networks that really sought to identify best ways to prevent, treat and manage HIV. And a lot of that evidence now that informs care in the U.S. now originates in sub-Saharan Africa, where, of course, the problem is largest. So that infrastructure was already in place and I joined it. There was not meaningful work occurring for cancer. So I went in 2012 and antiretroviral therapy scale up as a result of PEPFAR and other programs began in the mid 2000s in most African settings as compared with the mid 1990s in the U.S. So by the time I was living and working in Africa, not that the epidemic was solved, but people who were willing to get tested and wanted to come forward and be engaged in care could basically get the same care in the Lilongwe that they could get in Chapel Hill. I mean, they were literally getting the same medicines with basically the same outcomes. Many people returning to work and living long, healthy lives as long as they had a support structure in place that allowed them to access care and adhere to their medicines. Even in the U.S., when people with HIV are effectively treated for their HIV one of the principal causes of death very quickly becomes cancer, right? Because they live longer, so they age, which creates opportunities for acquiring many different types of cancer. Age is a strong, independent risk factor for most cancer types, but it also reduces competing infectious causes of morbidity and mortality in the HIV infected population. So this transition had occurred in the U.S. and was starting to occur in sub-Saharan Africa, although ART scale up started a bit later, about a decade later. So I was impressed by that. There was so much cancer, so much of it was HIV associated, all of this scientific rigor that had been brought to bear on the problem of HIV in sub-Saharan Africa. There weren't really people thinking with a lot of seriousness, writing grants about the problem of cancer. And so that partly, just as an early career scientist seemed like an opportunity, right? If I was going to do HIV and TB research, I was going to have to compete with Rob Murphy and Mike Cohen and people who are a lot more famous than I was. But doing cancer research, there was more of a window. And intellectually, if you think about how we provide cancer care in the United States, it's so complex, often and so multidisciplinary that I was really intrigued by the intellectual problem of how do you address this problem meaningfully in environments where the health care infrastructure is very different. So that problem attracted me and we were able to get some initial seed funding through the Fogarty, through the NCI. That allowed me to establish a faculty position based in Malawi, and I was impressed by how quickly things happen from there. This must have been how the early days of the HIV epidemic felt where there was so much work to do that even doing relatively simple things rigorously in this almost vacuum of evidence acquired this outsize importance. So even putting together cohorts where you tried to characterize patients carefully, treat them in a standardized way, know what happened to assess quality of life and patient reported outcomes, understand tumor biology. These relatively simple studies I think we actually learned a lot from and were able to attract collaborators all around the world, attracts a pipeline of young talent from both the U.S. and Africa. And then, perhaps most importantly, as an academic, successfully compete for funding to sustain those interests in that group and those lines of inquiry over time. So that's kind of what happened over the seven years that I was there. 

Rob Murphy, MD [00:18:10] The Durban AIDS Conference that was a turning point, and I think that was 2000 people said, Oh, you'll never be able to buy the drugs, you'll never be able to make generic drugs that people will never take them. You'll never be able to set up all these clinics. Everything was a no, no, no. And that meeting, I think, turned the world around. 

Satish Gopal, MD, MPH [00:18:29] It's such a good point. And so many people say that I was too young, I think, to be at that meeting. But I've heard that story so many times, and I always say we haven't actually had a comparable moment for cancer. Right? We're still having the same discussions. Can you treat these people? Will they take their medicine? It's exactly the same. I think in large part it's because we haven't had a seminal moment like that that has really galvanized not just the research community, but the broader community of stakeholders. And this is something I think about a lot now at the NCI and particularly as we operate in this reignited cancer moonshot environment, is what are the opportunities to create that kind of an inflection point for cancer that we've seen for HIV? And I really benefit in that way from being so strongly connected to the HIV community because I understand that history I think in a way that many people in the cancer field don't. 

Rob Murphy, MD [00:19:19] I think this is a really great segway. How did you get from Malawi to the NCI in your directorship program position at the NCI?

Satish Gopal, MD, MPH [00:19:28] First the NCI some listeners will know is the largest funder of cancer research in the world, and the institute was established in 1937 and reestablished in its current form by the National Cancer Act of 1971, where Richard Nixon signed into law the war on cancer, basically. And in 2021, we actually celebrated the 50th anniversary of the National Cancer Act, which was a really fun thing to participate in. Our Center for Global Health was established in 2011 by Harold Varmus when he was the director, and many of you will know that he now chairs the W.H.O. Science Council and has been actually a really important source of wisdom and support for me since I've come to the NCI. And the NCI has always been engaged in international research, and that engagement is distributed across the entire institute. But in 2011, it was. Felt that there was enough need and opportunity and coalescence of international interests that the NCI really needed a dedicated center to coordinate this. And so that's where I am now. So I was recruited a couple of years ago. So in 2019, the NCI conducted an international search for a new director and I was encouraged to apply and then eventually offered the job by Doug Lowy, who was the acting director of the NCI at the time. And I think what I was interested in is, you know, I had worked quite a lot with the investigators at the NCI, had been funded quite a lot by the NCI. So I was very familiar with the Institute but had never really been inside. I think there's not a higher concentration of cancer specific resources and expertise anywhere in the world frankly, the stuff that is done here is amazing. And so some of what I was intrigued by was the opportunity to use what I had learned in Malawi and then see if being here we could try to marshal together the leverage platform, experience resources of the NCI to have as much impact in the places like the clinic where I used to work in Malawi. To me, these segments, although they're very different, are also very connected. I still feel like I'm doing the same work. But you're right, it's from a very different vantage point. And in some ways I feel like what I think about on a daily basis is how can I make the NCI have greatest impact on the patients that I took care of in Malawi until coming here.

Rob Murphy, MD [00:21:38] Satish, I wonder if you could elaborate just a little bit more for our listeners of benefit. How can you really get an opportunity to pivot your career at a particular point and go from living in a low income country, building academic research program there, training all the people on the ground, plus staying on your faculty position in Chapel Hill, and then all of a sudden you're the director of the global health program at the NCI. I mean, that's a major pivot. 

Satish Gopal, MD, MPH [00:22:04] People can make pivots, but in trying to build a career, I think it's helpful if there's some linearity or a thread that runs through those different pivots. I am making this decision now for this reason, but it building on the kind of foundation that I've established until now so it doesn't actually feel as discontinuous to me, I think as it sounds, and I am still engaged in some of the work that I was doing in Malawi and still thinking about new studies and still mentoring young investigators in the field. So I guess in some ways it just feels like an enlargement expansion of what I was doing in Malawi, which in some ways I think I was ready for career wise because I think we had established a strong infrastructure there. The program had a fair amount of momentum. We had a lot of young fellows who became faculty members and were successfully competing for their own funding. So in some ways it was a natural time to consider transitioning, including to the NCI when the position was offered. To me. 

Rob Murphy, MD [00:22:58] It really does seem from the outside looking at you and the NCI, a pretty seamless transition. It's really incredible. But you're certainly prepared, experienced, doing a great job there. The keynote address you gave at our 2022 Global Health Day, which was hosted by the Havey Institute for Global Health and co-sponsored by the Robert Lurie Comprehensive Cancer Center at Northwestern. Your talk was entitled Toward Ending Cancer as We Know It Everywhere at the NCI Center for Global Health. Maybe if you could just make a couple of comments on the theme of that presentation. 

Satish Gopal, MD, MPH [00:23:32] The president has reignited the Cancer Moonshot last year, almost a year ago exactly. And in doing that, he called on the cancer research and control community to end cancer as we know it. I think many different people have different perspectives on what exactly is meant by that. But I think the basic understanding is to try to change the meaning of cancer as it's currently experienced in our society. And there are two specific goals that have been articulated. The one that people are maybe quite familiar with is to reduce the cancer death rate in the United States by half over the next 25 years by 50%. And we are certainly thinking a lot at the NCI about the role that we will play and the resources that we need and the programs that we want to develop to try to help meet that goal. Rob, you may remember the original Cancer Moonshot was announced by then-President Barack Obama in his State of the Union in 2016 and was led by then-Vice President Biden. And that effort was a fairly research focused effort in the sense that what the NCI did is we convened a broad community of stakeholders to try to identify research areas that were amenable to significant acceleration with some dedicated resources and commitment, identify those areas, and then receive new resources through the generosity of Congress to try to actualize those ideas. So many important programs at the NCI related to immunotherapy, pediatric fusion, onco-proteins, implementation science were generated out of the first phase of the moonshot. It's clear now that what is intended is no longer a purely research effort, but really at all of government, all of society approach to tackling cancer. That's what the White House is marshaling together. And again, we expect to play a leading role in that as the NCI and as the largest funder of cancer research in the world. I direct the Center for Global Health at the NCI. And so there are also important global health conversations that are ongoing as part of this larger cancer moonshot effort. And we are very much participating in contributing to deeply engage with the White House in trying to think about and formulate what that global health agenda might look like, along with many other partners. And so I always try to make the point that most cancer burden is in low and middle income countries and that we really won't be ending cancer as we know it. We really won't be changing the meaning of what cancer is without addressing that meaningfully everywhere, including in the clinic in Malawi where I worked before coming to the NCI. And so I think that message is heard. I think what is harder, given that even we as the NCI don't have the resources or capacity to address each cancer in every place all around the world. So then it becomes in some ways what the HIV community has effectively done. How do you put a coalition together? Who's responsible for what? How do you prioritize the greatest needs and try to address those meaningfully? And I think that's some of what we're hoping will be galvanized through this new moonshot phase. And again, we're really excitedly participating with the White House and many other governmental non-governmental partners in those dialogs and really trying to help lead a global perspective with a big inclusive g rather than we sometimes mean global to mean. We signed a memorandum of understanding between the United States and Europe, and that's global in a sense, but it's also not global in a sense, right? And so I think there's such an opportunity as has occurred with HIV, the amount of goodwill and benefit that was generated to the American people, to the United States as a country, from PEPFAR. One, all of our guidelines for HIV now are basically based on studies done in Africa. Two, just the goodwill that was generated and the opportunity to demonstrate us moral and scientific leadership. And I think there's a real opportunity along those lines for cancer as well. And, you know, we just have to marshal together the will and resources and partners to try to realize that

Rob Murphy, MD [00:27:21] PEPFAR, it really has been a springboard for many things. We work a lot with HIV-associated cancers, but we're also working in another area, looking at biomedical engineering programs and development in low and middle income settings so that the Africans we're working can actually make the devices and assays, including assays for cancer. They can make it themselves, they can decide what they want to do and where are they going to put their resources. It's been phenomenal. But that wouldn't have happened without PEPFAR, and I think we learned a lot from PEPFAR for what can be done, and it has been remarkable. One final question, Satish. Can you just tell us some general recommendations for a student? How can students get involved in a meaningful way working in your field, particularly in the cancer field, and have anything to do with the NCI? 

Satish Gopal, MD, MPH [00:28:09] So first, I mean, I would try to have an immersive experience. I think that's really important. I would try not to dabble indefinitely. I mean, a certain amount of dabbling I think can be useful to test the waters and whet your appetite. But again, I'm someone who believes that global health is a discipline and not a hobby. And I think if that's how you intend to pursue it, it requires that kind of commitment. And I think that at Northwestern, through some of our programs at the NCI, there are many groups that have been doing this for a while, have evolved their programs are thinking a lot about equity, can provide a structure for a really meaningful experience that will allow you to get a sense of, is this something I want to do for a long period or not? And then when you have the opportunity to have immersive experiences, just make sure that you're approaching them with the right amount of humility, with the right mentorship from both the U.S. and the low and middle income country where you're working. These kind of global health inequities have persisted for a long time, and they've largely been conceptual, right. The way that we are thinking about the work that we are doing. And so I think that reset is kind of occurring, but it occurs slowly in sort of one person and one project at a time to try to achieve the sort of culture change that we want. But really thinking about the LMIC collaborators that you're working with as collaborators and mentors and guides and learning as much as you can from them and trying to contribute what you can. Understanding that, particularly at an early stage of a career, your contribution might be modest and that's okay. Those are, I think, what I told fellows when they came to work with us in Malawi and I guess the advice I would offer to students now. 

Rob Murphy, MD [00:29:41] I can't thank you enough for taking the time to chat with me today and share all these wonderful experiences. I'm wishing you the best of luck with the rest of your term as director of the NCI Center for Global Health. 

Satish Gopal, MD, MPH [00:29:55] Thanks so much, Rob, for having me. It's been a real pleasure. I really enjoyed it. 

Rob Murphy, MD [00:30:04] 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.