PhD takes her from African peaks to European lowlands

Once a year, Dr Sweetness Laizer (31), a physician-scientist from Tanzania, packs her bags for a research visit to the Netherlands, where she is working on a PhD at Radboud University (RU).

She exchanges her office at the Kilimanjaro Clinical Research Institute (KCRI) in Moshi for a desk at RU’s medical centre (Radboudumc) in Nijmegen, where she is pursuing her PhD.

KCRI and RU have a long history of collaboration, which – according to Dr Quirijn de Mast, a specialist in infectious diseases at Radboud – is crucial in today’s interconnected world.

“Health is an international issue,” he told University World News. “COVID-19 reminded us again that the world is a global village. That’s why it is essential for us to collaborate.”

Laizer’s PhD research is deeply intertwined with her ongoing work as the study coordinator of a Phase III clinical trial at KCRI, which focuses on tuberculosis (TB) and diabetes.

Her PhD supervisor, Professor Reinout van Crevel, is also the project coordinator of the clinical trial. He is a professor of global health and infectious diseases at RU.

“She is very good,” he said about Laizer. “She is determined, has stamina, is self-critical, independent and a great communicator.”

Laizer’s journey highlights the triumphs and challenges of African students pursuing a PhD abroad, while also shedding light on her crucial research to combat TB, a significant public health concern in Tanzania and many other parts of the world.

She spoke to University World News in Nijmegen earlier this year, before returning home ahead of the European winter.

UWN: Please tell us a bit about yourself.

SL: I work in the zonal referral hospital in Moshi, Tanzania – the Kilimanjaro Christian Medical Centre (KCMC), specifically at its research institute, the KCRI. I am also a PhD candidate at RU here in the Netherlands.

UWN: What is it that you do at KCRI?

SL: I am involved in a Phase III clinical trial that aims to prevent active TB in diabetes patients with latent TB. It’s funded by the EDCTP [European and Developing Countries Clinical Trials Partnership, a public-public partnership between countries in Europe and Sub-Saharan Africa, supported by the European Union].

Coordinated by RU, the trial is taking place at two locations in Tanzania – Moshi in the north near Arusha, and Mbeya in the south – as well as in Kampala, Uganda.

UWN: How is the trial linked to your PhD?

SL: I started the trial in 2020 then, in April 2023, I got the opportunity to do a PhD at Radboud. One of the sub-studies was suitable for such a project, and I opted to do it.

UWN: Why do a PhD in the Netherlands?

SL: For one thing, I don’t pay tuition and my research is already funded – unlike in Tanzania, where I would have to pay for it myself or get a scholarship. But, more importantly, Radboud is highly rated, so this will be good for my career.

UWN: What is the link between diabetes and TB?

SL: Diabetes is a chronic metabolic disease characterised by high blood sugar levels. It increases the risk of heart disease, stroke and kidney failure.

Three out of four adults with diabetes live in low- and middle-income countries, and the number of people with diabetes is expected to increase dramatically in Sub-Saharan Africa in coming years.

This rise is concerning because many people in these regions lack access to good quality diabetes care, which can lead to serious health problems and even death.

In addition to the usual complications of diabetes, people with this condition are also three times more likely to develop TB, an infectious disease caused by a bacterium. It usually attacks the lungs and can be fatal if it is not treated properly.

People with diabetes are particularly vulnerable to developing active TB because the disease compromises their immune system, making it harder for their bodies to fight off the bacterium that causes TB.

Diabetes is responsible for about 10% of TB cases worldwide. Because diabetes is becoming so common, there are now more people with diabetes and TB than there are people with HIV and TB.

UWN: How will the clinical trial help?

SL: We are building evidence that prophylactic treatment for TB should be given to people with diabetes. There are drugs that are already given to people with HIV for this purpose, but they are not yet part of public health guidelines for people with diabetes in many countries.

UWN: And your PhD?

SL: I am identifying gaps in diabetes and TB care and developing strategies to improve health outcomes for those affected by both diseases, specifically in Tanzania and Uganda.

UWN: How did you get involved in research?

SL: I qualified as a medical doctor from Kilimanjaro Christian Medical University College at the end of 2018, but struggled to find work because there are not many positions available in Tanzania.

So, I did some online courses (in data management, systematic reviews, research implementation, clinical trials and global health), and then an MSc in Clinical Research at KCRI.

Workwise, I started as a research assistant, and then progressed from sub-investigator to principal investigator in a small project, and then to clinical trial coordinator.

UWN: Do you see yourself staying in research?

SL: I like it a lot. In routine care, you stick to the guidelines – if a patient has these symptoms … this is the treatment. But when it comes to research, you ask questions and try to find answers: ‘Why is the medicine not working? Why these complications? What can we do?’ So, it’s interesting and very stimulating.

I just wish the employment were more consistent, because projects are normally funded by grants for three or five years, so you don’t have job security.

UWN: How do you find collaborating with colleagues in Europe?

SL: Very useful. You meet different people who are very knowledgeable in their field. They ask questions that you normally wouldn’t think of.

UWN: And how do you find life in the Netherlands?

SL: Good – although the first time was a bit of a culture shock. This year, I was more prepared for the differences – the sun only sets at 9pm, the Dutch eat a lot of bread, and they cycle everywhere.

UWN: Have you started cycling?

SL: That’s funny. When I heard I was coming to the Netherlands, I had to learn to ride a bicycle. I had a few tumbles, but I got the hang of it. And then I came here, just to realise everybody’s tall and the bikes are bigger! So, I had to learn some more. But, now, I ride my bike everywhere, like everybody else. It’s another life skill for me!

UWN: When do you aim to finish your PhD? And the clinical trial?

SL: In the next two years … hopefully! [The clinical trial] will run for three more years.

UWN: What lies ahead for you, careerwise?

SL: I want to keep working in research, helping to solve public health challenges in our region. Hopefully, I can keep learning, earn more grants and positions, and end up – who knows – maybe in the ministry of health, the centres for disease control, the World Health Organization, the International Diabetes Federation … one can only dream.