Fulbright fellow focuses on underserved populations

We catch up with medical alumna Dr Sainimere Boladuadua who was awarded a prestigious Fulbright Science and Innovation Graduate Scholarship in July 2024.

As well as graduating from Otago with an MB ChB in 2002, Sai has a Diploma in Obstetrics and Gynaecology from the Fiji School of Medicine (2006) and a Master of Public Health (Distinction) from Otago in 2011.

On receiving the Fulbright award, Sai said, “as an iTaukei woman, I represent my family, my villages, my vanua, I carry all of them with me. All my work, including my achievements and failures are a reflection on them.”

“I am acutely aware of the privilege of being able to access this opportunity, it’s something I don’t take lightly. With this privilege comes an obligation to use the amazing opportunities afforded to me such as this Fulbright award to make a contribution to the society in which I live, which spans both Aotearoa New Zealand and the Pacific.”

Q Where are you working at the moment?

I’m a public health physician. I am doing doctoral studies at Waipapa Taumata Rau University of Auckland and am currently on a break from that to do a Fulbright fellowship at the Johns Hopkins Bloomberg School of Public Health’s Center for Indigenous Health in the United States (US).

Q Back to the beginning – why did you decide to study medicine at Otago?

Growing up in Fiji, I’d heard of people from Fiji going to study Medicine at Otago. While Fiji has its own medical school (it now has two), a number also had the opportunity to study in New Zealand and this was mostly at Otago.

Studying at Otago became a personal aspiration for me. We have quite a number of notable Otago Medical School alumni from Fiji. One of our founding fathers of post-independent Fiji and our first Prime Minister, the late Ratu Sir Kamisese Mara was arguably the most well-known. I read his biography, The Pacific Way – A Memoir, recently and he speaks fondly of his times at Otago. Dr Mutyala Satyanand, the father of former New Zealand Governor General Sir Anand Satyanand, was another.

I was fortunate to receive a Fijian Affairs Board scholarship to pursue my medical studies at Otago. I still remember the words of our Prime Minister at the time, the Hon Sitiveni Rabuka, who addressed our group during our induction. He urged us to go and gain our qualifications and training, and return to help build our nation. That message has stayed with me ever since, and it continues to inspire my academic and professional pursuits. While my professional path has centred on healthcare, it’s part of a bigger commitment to contribute to national development.

Arriving in Dunedin straight out of high school was a bit of a culture shock – it was my first time away from home. Fortunately, I was quickly taken under the wing of more senior Fijian students, who helped me find my footing. I also found a church that many of them, along with other international students, attended, and that became my community for the six years I spent there.

Q What were some of the highlights of your time at Otago?

Staying in a hall of residence in the first (Health Science) year was a highlight. I got to meet and make friendships with people up and down the motu as well as from overseas.

I particularly enjoyed my attachments outside of Dunedin, such as my fourth-year med rotations at Kew hospital in Invercargill, fifth-year attachment in Oamaru hospital and GP attachment in Hamilton. These gave me the opportunity to see a bit more of New Zealand and whilst the primary focus was on learning clinical skills and patient management, it gave me first glimpses of the different challenges at different levels of healthcare and the communities’ access to healthcare.

Another highlight was the three-month Trainee Intern (TI) elective. I think this was the highlight of any medical student – to be able to go anywhere in the world to do medical specialties of interest!

During medical school, I loved going to the med library and poring over volumes of TI elective reports from previous years. My elective run was in the last quarter of TI year, so it was a great time to consolidate learning as a budding clinician with minimal responsibility and do a bit of travel before starting work as a house officer.

I had wanted to go to South Africa, but those plans fell through so instead, I did six weeks of Orthopaedic Surgery (an area of very real interest then) at a district hospital in Cambridge, United Kingdom, and six weeks of Obstetrics and Gynaecology at Fiji’s Colonial War Memorial Hospital.

Q What did you take away from your time at Otago that continues to influence you?

I just loved the sense of community we had and continue to have. Being a student city, everything revolves around the students, including student discounts at most retail stores.

Friendships that I made from those six years in Dunedin have continued to date and the greater Otago alumni network is something special. You have a special bond when you meet someone who went to Otago, as you straight away start reminiscing about times at the Cook or at the Terraces of Carisbrook aka The House of Pain or swapping stories of living in freezing student flats – all part of the Scarfie experience!

One thing that we had in our clinical years was a mentorship programme where we were buddied up with senior practising clinicians. I had a delayed appreciation of the importance of mentorship but have had many other both formal and informal mentorships since then that have been so crucial and beneficial to my own professional and personal development.

The University of Otago and its Medical School played a formative role in shaping my higher education and academic journey. Moving to Otago from high school in Fiji opened my eyes to a broader world of opportunities – both professionally and academically – all guiding me toward a deeper sense of purpose. I believe that everyone has a purpose to fulfil, and for me, that includes working to improve the health of underserved populations.

Q Could you tell us more about your Fulbright fellowship?

As I mentioned, I’m with the Johns Hopkins Center for Indigenous Health (JHCIH), which works in close partnership with Native American communities across the country to improve health outcomes and wellbeing.

Within JHCIH, I’m part of the Infectious Diseases prevention team and have contributed to a number of research projects. What I’ve particularly valued – and consider a privilege – is the opportunity to work across both worlds: learning from Indigenous health leaders, traditional knowledge, and community-based practices in the Navajo and White Mountain Apache communities, while also being based at the Baltimore campus, surrounded by public health thought leaders and academic experts.

One of the key projects I’m involved in is the Surveillance for Respiratory Syncytial Virus (RSV) and other respiratory infections among American Indians and Alaska Natives (SuNA), a five-year surveillance study. My specific focus within this project is analysing human metapneumovirus among hospitalized Indigenous children and adults.

A key goal of my Fulbright research exchange has been to explore how Indigenous and Western health knowledge and practices can complement each other to improve healthcare access and outcomes. Throughout my time at JHCIH, at our research sites in Navajo and White Mountain Apache tribal communities, and within the Indian Health Service (IHS), I’ve learned a lot and gained invaluable insights into this intersection.

It has also been an interesting time to be in the US, witnessing the elections, a change in administration, and the resulting shifts in foreign policy, as well as public and global health policy.

I’ve learned a great deal about US history, governance, Native American history, and how the tribal governance system and IHS fit within the broader healthcare landscape. This experience has deepened my understanding of historical structural inequities, their lasting impact on Indigenous health outcomes and wellbeing, as well as learning about approaches to address these inequities.

Beyond the professional spaces and the academy, the Fulbright fellowship is a cultural and educational exchange, and I’ve fully embraced that. From immersing myself in different facets of American culture to building relationships and exchanging knowledge, this experience has been enriching both personally and professionally. As I reflect on my time here, I’m continually thinking about how I can apply these learnings in the professional and community spaces I’m part of in Aotearoa New Zealand and Fiji.

A few of the other highlights of my time as a Fulbright fellow:

• Attending a Women’s International Leadership Summit hosted by the Johns Hopkins School of Advanced International Studies. Keynote was by the President of the Republic of Kosovo, H.E. Vjosa Osmani.

• Being part of a JHCIH group invited to meet with a Greenland government delegation to talk about our work with Native American communities. Greenland's population is 88 per cent Inuit (Indigenous) and they were keen to learn about reorienting health system and health service delivery for Indigenous peoples. I was able to share with them a bit about my research in Fiji and Aotearoa New Zealand around understanding the intersection of traditional/Indigenous, faith-based and western biomedical worldviews, to better understand and improve Indigenous peoples' access to healthcare.

• Attending a week-long JHCIH Winter Institute course: An interdisciplinary approach to understanding the health of Native Americans.

• Giving a guest lecture on a JH Bloomberg School of Public Health course Power & Practice in Global Health: Theories, Perspectives & Action in "decolonization". My talk was titled Reimagining global health – a Pacific perspective.