In this edition, Satish Gopal, MD, MPH, talks about how being a second-generation Indian American informed his career in global health.
Where did you grow up? What was your childhood like?
I grew up in suburban North Carolina, the son of Indian immigrants. While I had a fairly typical American childhood in many ways, I also had a distinctly Indian-American experience. From the time I was very young, I traveled to India to visit family every couple of years. Early on, I was aware that I was fortunate to have a happy, comfortable life largely because of decisions my parents made and their hard work.
What was your first job?
Because I was academically oriented, I spent my summers during high school and college largely pursuing experiential opportunities, such as volunteering and interning to prepare myself for college and medical school, rather than working more conventional jobs.
The summer between college and medical school, I decided I should get a job involving physical labor, so I bussed tables at a sports bar. My family thought this was an odd choice when there was no real reason for me to do it. Even the manager of the restaurant kept asking if I wouldn’t rather wait tables – a more prestigious job within the restaurant ecosystem.
But I’d always felt it was important to understand what that type of work was like, despite it never being required of me because of the life that my parents had provided. I wanted to have that experience before I started medical school.
What did you want to be when you grew up? Is there another career you could see yourself in?
From a young age, I had seen myself going into medicine. Culturally, Indian-Americans are often encouraged to pursue careers in medicine or science. So, although I did not feel pressured by my parents, I did not encounter any opposition – you don’t typically have to fight your parents to become a physician.
I was attracted to medicine because it was a unique blend of science and humanities, well-suited to my temperament and the way I thought about the world. I liked the precision, rigor, and inquiry traditionally associated with science, but also enjoyed more humanistic disciplines – literature, in particular. Medicine brings together those different worldviews in way that attracted me.
Walk us through your career. What drew you to global health?
After medical school, I went through residency training in internal medicine and pediatrics. I think my interest in global health stems from childhood experiences in India. I was aware at an early age that not everyone has access to the same health care, resources, opportunities, and education. That awareness – along with a feeling that I was fortunate and had access to a lot of privileges that had nothing to do with my own ability or efforts – informed my desire to pursue medicine as a way to help other people.
I pursued some shorter travel opportunities during medical school and residency, but intentionally waited to pursue a career in global health until I could practice independently and at least contribute as a clinician in low- and middle-income countries.
I also met my wife during this time, who had similar interests. She was finishing a graduate degree in education focused on immigrant populations and educational issues in low-
income countries. So, we decided to seek out opportunities to work abroad, eventually moving to Tanzania with our infant daughter from 2007 to 2009.
Meeting my wife and having her interests reinforce mine allowed us to pursue this together as a career and as a life. Global careers can be difficult to sustain if one person is dragging their partner along everywhere. Fortunately, we were both engaged in this endeavor and have continued to be for the last 10 to 15 years.
I initially thought that I would end up being a clinical HIV researcher or infectious disease physician-scientist based on my inclination toward global health. During our time living in Tanzania, however, HIV treatment was already being scaled up in sub-Saharan Africa, so a lot of the biomedical questions that I was interested in had already been answered or were already being addressed by people much more famous than I was.
With HIV treatment advancing on such a large scale, the focus was rapidly shifting to the implementation, economic, or policymaking spheres. I honestly did not see as much space for a young, biomedically oriented investigator to explore the clinical, translational, bench-to-bedside questions that I was primarily interested in.
When did hematology/oncology enter the picture?
I had not been that interested in hematology/oncology, but this changed dramatically during the two years I lived and worked in Tanzania. By then, there was a rapidly growing cancer burden in the country, mostly associated with HIV.
The availability of antiretroviral treatment for HIV extended patients’ survival and, in some ways, opened up the possibility for people infected with HIV to develop cancer. The question of how to deal with cancer, which of course is itself a vastly complex set of diseases, in low-income countries where the resources are limited piqued my curiosity.
So, paradoxically, I became interested in oncology while living in a low-resource environment where there was limited capacity to deal with cancer, not in a cutting-edge laboratory or clinic at a U.S. cancer center. After two years in Tanzania, I moved back to the U.S. and pursued hematology/oncology training to develop that career trajectory. Then, I initiated a career as a National Institutes of Health–supported physician-scientist focused on cancer in low-income countries.
Looking back, my career has had a fairly linear trajectory, but not one that I could ever have planned. I was just trying to find opportunities to do meaningful work that I cared about. By doing that in a sustained way over a long period, I somehow created this career that probably went much better than I would have expected from the beginning. I suppose, to some extent, that’s what building a scientific career is like for everyone – engaging in a sustained inquiry about a set of issues you care a lot about and caring enough that you’re willing to accept failure as a reasonably likely outcome.
Tell us about your life outside of medicine – what are your hobbies? What do you do in the off-hours?
Maybe it’s obvious, but we enjoy traveling. The opportunity to work and live abroad with our two daughters, ages 13 and 11, has been amazing. It’s immensely rewarding to see our children experience different parts of the world and different cultures. I like to think these experiences have informed the types of people that my daughters are becoming, and that our family’s experiences will have a small net positive effect on the world.
It feels like we don’t have as much free time as we’d like these days. With the COVID-19 pandemic, the lines have blurred significantly between when you’re working and when you’re not. Like many parents, our lives are consumed by shepherding our kids around to their various activities, like soccer, which are slowly resuming even now in the COVID environment. We all enjoy sports and being outdoors, so that’s how we tend to spend our time together.
Do you have a favorite place that you’ve lived and worked?
Before I joined the National Cancer Institute in 2020, my family lived in Malawi for seven years. There, I led the cancer program for UNC-Project Malawi, a research and care collaboration between the University of North Carolina at Chapel Hill and the Malawi Ministry of Health. Malawi is a beautiful country in southeastern Africa whose people were extremely generous to us. We made great friends and loved what we were doing. Though we were not intending to leave, I ultimately chose to leave work that I loved in very capable hands when presented with the opportunity to join the NCI.
Malawi will always be a special place for my family because it was such an important part of a formative period in our lives. We’re all eager to return soon and, in many ways, we still think of it as home.
What is the first thing you are going to do when the COVID-19 pandemic ends?
Travel, of course. I think there are some positives that will come out of the pandemic. For example, not all travel is necessary. Holding events virtually is better for everyone’s carbon footprint. It’s less costly and increases the accessibility of scientific meetings for people from low- and middle-income countries where the cost and time needed to travel is often prohibitive.
At the same time, there is no replacing the opportunity to get together with likeminded colleagues and share ideas. Hopefully, we will find our way back to a hybrid model that preserves the lessons learned from the COVID-19 pandemic and gives people the opportunity to meet in person again.
What is one thing most people don’t know about you?
I studied music and piano performance as an undergraduate in college. Sadly, other than listening to music and attending concerts before the pandemic, music isn’t a big part of my life now. I went through a long period during which I lived in places without regular access to a piano and have struggled to rediscover a hobby that I once pursued pretty intensely. But music is something I treasure and I’m actively trying to revive this interest now.