For the Medical Record - Julia C. Interview ===

Mia Levenson: [00:00:00] Hi, and welcome to another episode of For the Medical Record, a podcast from Johns Hopkins University's Center for the Medical Humanities and Social Medicine. My name is Mia Levenson.

Richard Del Rio: And I'm Richard Del Rio. Our guest today, uh, wrote a passage that I thought really captures. The essence of this conversation that we're gonna have, and, uh, Julia Cummiskey wrote, "As individuals in society are still, we're still reeling from the impact of the COVID-19 pandemic. Many of us are, again, reflecting on where viruses originate, how we rate, generate knowledge about them, whose knowledge is reliable and whose is not. Few major outbreaks are truly local in the sense that they do not concern the rest of the world. And yet every outbreak is local in its impact in the question of what [00:01:00] resources are available to respond to it, and in the complex factors that determines its course and outcomes. She wrote a book that shows why in the history of global health, we need to make a habit of looking beyond the major centers of knowledge production like New York or Atlanta, London, Geneva, or Beijing by telling the story of the Uganda Virus Research Institute and Importantly shows how Uganda became a darling for important public health research, not only relevant to Eastern and Central Africa, but for global epidemics such as HIV and AIDS. I, I'm excited about this guest because she challenges conventional boundaries between field-based and laboratory research in virology with the argument that if an authentic reframing of global health is to take place, researchers and practitioners will have to move past the facile distinctions between local and global expertise and the assumptions about which people and institutions abide to each.

Mia Levenson: Here [00:02:00] to talk, uh, about her newly published book from Ohio University Press "Virus Research in 20th Century Uganda: Between Local and Global," we have Julia Cummiskey. Julia is an assistant professor in the History of Medicine here at Johns Hopkins. Welcome, Julia.

Julia Cummiskey: Thank you. Thanks. So, I mean, Mia and Richard, I'm so excited to be here and, and thanks for your, your kind words about the book. It's, it's always nice to to know that a project that's so exciting to me can also generate excitement in others.

Mia Levenson: Yeah. Yeah. We're really excited to, to talk about it. So, just to start off, tell us a little bit about your book and how did you come to the Uganda Virus Research Institute as your subject?

Julia Cummiskey: There are a lot of different ways I think I could characterize the book. In one way, it's the history of an institution, the Uganda Virus Research Institute, which was founded in 1936 as the Yellow Fever Research Institute, and has operated continuously since that time. And I came to the project, I, I don't have a great origin story here, but um, I remember looking [00:03:00] to see sort of what kinds of histories people had written that were centered at institutions or around people based in Africa. And I found this one page profile of the UVRI written by one of its former directors, and I was intrigued. It was just, you know, a page or maybe a page and a half about this place.

And I thought, well, I wonder what historians of science and medicine have written about the impact of this place. And I couldn't find anything. And from there it just kind of grew. Originally I conceived of it really as a project about a place that did a lot of HIV and AIDS work. Building on the work of people like Johanna Crane, uh, "Scrambling for Africa" and thinking about how places in Africa become really valuable as places where researchers based in the United States and in Europe can do HIV/AIDS research.

But what became clear really quickly was in order to understand the HIV/AIDS research done at this place, it was really important to understand the research that they've been doing for decades before HIV and AIDS and that that was a really important context. And so it evolved into a project really about [00:04:00] what does global health look like if you look at it from the vantage point of Entebbe, Uganda instead of any of those places Richard mentioned, and one of the things that I realized over time was that this binary between local people affects researchers and global institutions, researchers, institutions really broke down from that vantage point, and that helped me to look at this whole story in a new way.

Richard Del Rio: In the first chapters of this book, which I found interesting, you point out that the efforts of scientists in Uganda illustrated tensions between what you call the imperatives of colonial medicine on the one hand and the ascendant language of internationalism and international health from the other.

For our listeners who maybe are not as familiar with those concepts, as we build forward towards the modernization of the Viral Institute, can you give us a sense of that tension and, you know, could you also just define these terms so we kind of have a common way of understanding it?

Julia Cummiskey: Yeah, I'll do [00:05:00] my best.

Richard Del Rio: Please.

Julia Cummiskey: So in the first chapter, I I wrote about the work done at what was then the Yellow Fever Research Institute between 1936 and 1950. And in that period, the institute was a joint venture between the Rockefeller Foundation's International Health Division and the UK, the United Kingdom's Colonial Government in Uganda.

And it was staffed by a combination of, um, US, Canadian and British scientists. And this isn't a period where international health as a concept is really, as you say, it's sort of ascendant. And a lot of people who were doing the kind of work that in earlier generations might have been called tropical medicine, were now calling what they were doing international health.

And so on the one hand, particularly the International Health Division of the Rockefeller Foundation, they really prided themselves on generating knowledge that was going to be universally applicable, valuable to the whole world. The IHD was very interested in [00:06:00] making the whole world safe for commerce. Um, and there's been some really wonderful work by people who have studied the history of the International Health Division and its impact, its goals, and that was absolutely consistent with what was going on here. And in one way, the goals of the Rockefeller Foundation and the British Colonial Government were really consonant.

Julia Cummiskey: So their big concern at this point was that yellow fever, which they really had believed, um, until not very long before the institute was founded, was primarily in Africa, in West Africa. They believed that it was a West African disease that had then traveled to the Americas, was found other places they didn't think it was an issue in East Africa.

And the International Health Division had sponsored a series of sero surveys where they'd gone around, um, different parts of Africa and collected blood specimens from really hundreds, thousands of people and identified what they were confident were yellow fever antibodies from people living in places like Uganda, where there was no clinical record of anyone having been infected with yellow fever.

Now this was controversial because they were basically identifying what [00:07:00] some people called, um, invisible or silent yellow fever. And this was really scary because their greatest fear, and again, this was a fear shared by, um, commercial interests and government interests, was that yellow fever was actually traveling across the continent and that it would arrive in the eastern port cities of Tanzania. And then get on a ship and end up in the Indian subcontinent, which had known populations of the kinds of mosquitoes that carried yellow fever, but did not have yellow fever virus circulating. And so the fear was that Africa would become a source of yellow fever that would infect the Indian subcontinent and that would be catastrophic.

And so they weren't sure whether there was something that was stopping the spread of yellow fever, eastwards. Whether there had historically been something that stopped it and that it had been somehow, violated as they were desperate to know what's stopping yellow fever from getting to the coast, and how can we make sure it, that that barrier, so to speak [00:08:00] persists.

And so in that sense, their goals were very aligned. Um, but there were times, and I don't go into a lot of detail about this because it wasn't really the path that I went down, but you know, there were times when, for example, some people were really interested in making information public as quickly as possible, right, to enhance their scientific credentials or to share information when, when at times, you know, the government interest was more in protecting information.

This was particularly true during World War II when, um, you know, this, this idea that scientists from all different countries were collaborating was challenged by the needs for national security. Scientists from countries that were, were now adversaries in the war were obviously not allowed to share information.

So it was challenged from time to time. But generally speaking they were, they were pretty much, um, on the same page. I think I've lost track of your original question.

Mia Levenson: So the original question was thinking about the sort of tensions between colonial medicine and then internationalism. And I [00:09:00] think to follow up on this too, right? So in so much of your book, you're really trying to deconstruct this binary between local health and global health. So maybe just to add on to that previous question, to think a little bit through what these terms mean in your book and sort of why you're trying to deconstruct this binary.

Julia Cummiskey: Oh, great. Yeah. And, and, uh, one, one point that I, I should have made earlier about this, um, I think the other place where this difference between sort of colonial medicine and international health came up was that from an international health perspective, understanding where yellow fever was was really important. From a colonial medicine perspective and again, I mean the, you know, there are li-, well, there are substantial parts of libraries that have phenomenal histories of colonial medicine and health. And you know, many of them conclude the primary objective of most colonial health operations was to protect the labor force and to protect Europeans from disease that they perceived as circulating among Africans. And in Uganda, yellow fever was not a problem for colonial medicine. Like there were not people getting sick with yellow fever to the best of their knowledge. And so there were these [00:10:00] colonial doctors, many of whom had spent years and years working in East Africa who were saying, "how dare you say, we've just missed yellow fever. Um, you know, your antibody test must be wrong 'cause we would know." And so there was this tension about where resources went. Even after it had been pretty well established that indeed there was some yellow fever happening. It still was nowhere near the top of the list of things making people sick in East Africa. So that was a real tension.

In terms of these binaries, it does tend to presume that local is somehow separate from something else, whether that's global or international or cosmopolitan, and what I really want to say in the book is that it's not that local or global isn't meaningful, it's that they're only useful in a relative sense, that there's no such thing as a local person or a local place. They're only local vis-a-vis somebody with a different position. And, and that's not an identity that sticks with the person or the place of the institution. And in fact, what's so interesting, and this is true for the colonial versus international too, [00:11:00] is I find that researchers and people administering these research institutions very deliberately adopt different relative identities as local or not when it's useful. And so sometimes it's really useful for a researcher based in Uganda to emphasize their locality, even if they are a, somebody from Scotland to say, "no, I am the local expert on bwamba in Western Uganda. I've been here for years. I know the people, the plants. I am the local expert. And so you sitting in Geneva, you, you can't question what I have to say." And that same person can turn around and say, "I am a scientist with an international reputation. I have done work in 14 different countries, et cetera, et cetera. I'm an international expert and that gives me credibility in different ways."

Richard Del Rio: This is jumping ahead a little bit, but I feel like you really lend towards this question by just your, your, your previous statements, the comparison between Yellow fever, its relevance to the locality, to global reach, it's an interesting comparison to [00:12:00] jumping forward to HIV/AIDS and, uh, even within the context of Uganda as a colonial possession during the mid 20th century. It's going through a process that's described as Africanization. It's a post-colonial period. And they're dealing with an epidemic that has connotations in the United States, has connotations with queer white men. Right? And Uganda, it's there- you kind of described the dis- not necessarily discovery, but rather the kind of the, the framing of a concept called African AIDS.

I would love to kind of take this distinction that you've, that you're talking about. Can we talk about it in terms of HIV, uh, context?

Julia Cummiskey: the concept of African AIDS, I adopted, um, really from the work of people including Cindy Patton, who have done analysis on the way we talk about AIDS. So just to be clear, African AIDS is not something that is biologically distinct from AIDS anywhere else.

[00:13:00] And it's not, um, I don't wanna say it doesn't have any reality. It does have a reality, but it's a reality that's created through discourse primarily. But it was, you know, as I say, Cindy Patton has sort of identified it in it. And once you, once you're aware that it's happening, you start seeing it, that first implicitly and then very explicitly, people assume there's something different about AIDS in Africa. And this is, as you say, because at the time that the first AIDS cases in Africa were being documented and investigated, they were, um, apparently primarily among heterosexual men and women, and about half men, half women, which was really different than the epidemiology of AIDS as it was then unfolding in the United States and Western Europe. So there was a lot of skepticism that this could be the same thing. And then immediately a lot of people trying to understand why did the epidemiology of this virus infection look so different in these different places?

And there was a lot of early research that I and others have argued, reflects some of [00:14:00] the preconceptions and prejudices about Africans and in particular African sexuality that date back to the Colonial period. What I think is really interesting about looking at this from the perspective of the UVRI and in the HIV and AIDS section of the book, I'm, I'm really looking at, uh, a project called, that's now called the Rakai Health Sciences Program, which exists under the umbrella of the UVRI, but is not the entire UVRI.

And what I was really interested in is, well, how does that play out? Right? How do these assumptions get built into the research and what else is going on? Because that's not the only thing happening. On the one hand, there are ways in which some of the research that took place in the 1990s in Uganda, I think really was interpreted globally as fitting this African AIDS model. But that's not what it was designed to do, certainly, and there are lots of ways to think about why it unfolded that way, which include, but are not limited to that African AIDS discourse. But this has been one of the challenges of the AIDS pandemic, right? Is understanding the ways in which something can be both the same and [00:15:00] very different, right?

Mia Levenson: And of course there is, there is biological diversity in HIV. But that is not really what explains all the variability. And of course, like I would argue every epidemic, um, epidemics are not just biological phenomena, of course, I think readers or listeners to this podcast are not gonna need to be reminded that epidemics are political, they're social, they're cultural, and I think that goes a long way to explaining why these things are different. And then the challenge, particularly in a context where so much science has been informed by really problematic ethnographies that seek to reduce phenomena in Africa to ethnographic distinctions that can be established, that are stable, that are immutable and that are mutually exclusive really contributed to this.

You were talking about the sort of inextricability between the sociopolitical conditions under which the UVRI is operating and what they are able to research. One of the things that really struck me about your book is that in your [00:16:00] book, you divided it into these three parts, right?

Mia Levenson: You have the, the yellow fever period from 1936 to 1960, Burkitt Lymphoma in the sixties and seventies. And then finally what we've been talking about HIV/AIDS from 1980 to the end of the 20th century. And so I was wondering if you could speak, to how you sort of set on these, uh, different periods, how you decided to, to divide your book up?

Julia Cummiskey: Yeah, I, I think the simplest answer, which is also true, is that it was really about, as I was going through both the publications of the institute and also the annual reports of the institute, that these three diseases or putative viruses really were disproportionately large parts of the research agenda in these three periods.

So of course, in the earliest period, yellow fever, I mean it was right there in the name, right? It was the Yellow Fever Research Institution Institute. And they, their funding was [00:17:00] contingent on their ability to produce useful findings about yellow fever. After they had successfully isolated yellow fever virus, they needed to continue to justify their existence, right? They had basically solved the problem that they were sent there to solve, or at least part of it, which was to validate the antibody results, to validate the presence of yellow fever in this area. But they were further charged to explain how it was spreading. Again, with that goal of being able to figure out how to prevent it spreading further.

Particularly after World War II, um, and I think this is in some ways due to the efficacy of DDT and other insecticides and the success of the yellow Fever vaccine, that became a less pressing issue in many ways. Um, and around that time in 1950, they're also transitioning from being funded by the International Health Division to being fully funded by the colonial government.

And the colonial government was answerable to a different constituency than the Rockefeller Foundation was. And they [00:18:00] really, in order to continue getting funding at the level they believed was necessary, they had to point out how they were gonna be a value to people living and working in East Africa.

Now, again, in the 1950s, they're not really accountable to most of the Africans living in Uganda in this period. It was mostly colonial officials and colonial interests. It was much more necessary for them to show how they were going to be generating knowledge that would be translatable into policy, treatment, prevention for diseases that people perceived people in East Africa were suffering from, which again, was still mostly not yellow fever. They also were facing what they feared was a crisis of relevance. In the 1930s when the institute was founded, virology was in many ways, a kind of maverick science, there was a lot of improvisation.

Um, a virus was defined still in 1936 as something that causes disease, which is so small, we can't filter it out with our finest filters. By the [00:19:00] 1950s, the definition of a virus has become much more specific. There are much more advanced techniques and technologies that are being applied in virology.

Um, it was a field that expected a lot more specialized training, whereas the first generation of scientists at the institute had been trained as bacteriologists, entomologists. Um, virology was becoming more specialized and, and in some ways more esoteric. And they were worried that this wouldn't be a place that was seen as producing real virology insight.

And so this was a dilemma through the 1950s when they were still largely conducting ecological studies. The colonial government in Uganda, like in many African countries, had not invested in higher education and training to create African born scientists. So they were, quote unquote catching up. I don't, that's not quite the right way to praise it, but they couldn't replace them immediately. And some of the people who had invested decades of their career in this institute feared [00:20:00] that it was it was really going to become kind of antiquated and, and not useful. And the director in 1952 was a man named Alec Haddow, uh, who I write about quite a lot in the book. And he was really, I think, searching for a new core mission for the institute that would organize what had become some really disparate sort of passive investigation and be seen as really high profile in the broader medical research community. And he came across what was becoming identified as a new kind of cancer or a newly recognized kind of cancer. This was Burkitt Lymphoma. So Denis Burkitt was a surgeon working in Kampala, and he started noticing children with these really aggressive tumors largely in the jaw and in other parts of the head and neck, and he didn't remember seeing them before.

This is a really interesting case [00:21:00] where, and this happens multiple times in the institute's history where people go back to these historic records. So in this case, Albert Cook, missionary doctor in Uganda from the turn of the 20th century. And he went back to Cook's notes and he actually, he found drawings that Cook had done of patients that indicated that this cancer did actually exist. It hadn't been identified as a separate thing.

Anyway, so he's investigating it. He does this whole project, which I talk about in the book. And people like Marissa Mika, and others have written a lot about Denis Burkitt and his research and the research into cancer in Uganda. But for my purposes, the, the part that was really significant was that after he'd mapped the distribution of these tumors, he showed his map to Alec Haddow or Alec Haddow came across it somewhere, and Haddow observed it looked a lot like the distribution of yellow fever across the African continent. And Haddow suggested, not that it was related to yellow fever, but that it might also be due to a mosquito transmitted virus. And in the 1960s, cancer virology was hot. Um, you know, for a long time people had been trying to convince, [00:22:00] doctors had been trying to convince lay people that cancer wasn't contagious.

But recently, relatively recently there was, they had identified a virus that did cause tumors in chickens, and they were theorizing that actually human cancers, at least some of them might also be linked to viral infections, which is what we now believe today meant that not all but many cancers are in fact, linked to viruses, or bacteria.

So I, I, the way I characterize it in the book is there was like a race to find the first human onco virus. And Haddow thought, okay, we might, we might be able to be part of that. And again, for lack of a better word, it was sexy. And so he really, and his successors poured a lot into saying, "we here in East Africa and Entebbe, we are one, we are in one of the few places in the world where you can reliably find large numbers of patients with Burkitt lymphoma. And we know how to investigate viruses, particularly mosquito-borne viruses. So if you are working in Bethesda or New York or Geneva [00:23:00] and you want to be on the team that discovers the first human onco virus, you wanna be working here in Entebbe."

And it worked, um, depending on what you mean by worked, right? They were able to attract partners in this quest. And they were also able to say to the government in the East African community and then later in Uganda, that unlike Yellow Fever, Burkitt lymphoma, was something that Ugandans were suffering and dying from.

Richard Del Rio: I would love to know what mid 20th century mosquito viral infection research looked like. What, what did they have? What, what did the work, what did that work look like?

Julia Cummiskey: Yeah, that's a great question and it's a great question in all of these periods, 'cause it looks really different. Um, I can't remember off the top of my head when electron microscopy first, uh, came out, but I, it was, you know, after the institute had been operating for a long time and they didn't get their first electron microscope until many years after they'd come across, so mid-century. Okay. So in the 1950s, a lot of it was- they used enormous amounts of lab [00:24:00] animals, basically. So it is still a real challenge for people studying viruses to study viruses in vitro, right? You have to basically have cell lines, cell cultures. So in the 1960s that technology was being developed and part of what the institute wanted to get from its partnerships around Burkitt lymphoma was for people from labs in, particularly in England who had that technology to actually bring it to Entebbe and train the Entebbe scientists in how to, to do cell culture work.

But up until that time, and even after that time, a lot of what they would do, so if they were trying to, um, they were trying to isolate a virus. So what they would do was take samples from people, or from mosquitoes or from monkeys, um, break the blood down into components and then inject them into mice or rabbits or chickens, or all sorts of other animals and basically see what happens. And then if an animal got sick, then they would take a specimen from that animal and see if they could transmit it from that [00:25:00] animal to another animal. Um, I'm not doing justice to the complexity of this, but they, I mean, the institute at the time, there were multiple buildings that were dedicated to just housing the laboratory animals.

Um, and this was true from the 19th, I mean, if you look at the records of the institute in the 1930s, the 1940s, the 1950s, I mean, the amount of pages. That are dedicated to how do you, what do you feed the mice to keep them alive and to keep them reproducing is enormous. I went into this project thinking I was gonna learn a lot about laboratory technique and I learned a lot about how do you maintain populations of lab animals and a lot about maps. 'Cause that's another big thing they were doing was mapping where they collected these specimens with the results they found in the laboratory. And so I ended up spending a lot less time than I expected to, looking at descriptions of laboratory experiments and a lot more time looking at maps and about sort of operational stuff.

Now, just to be clear, if you go to the UVRI today, it's high tech. I mean, they are, they have incredibly advanced instrumentation, computer setups. I [00:26:00] don't mean to suggest that the virus research they're doing today looks fundamentally different than what you would see if you went to a lab at Johns Hopkins, but in the 1960s it really did. And that was a challenge. Um, and so this is, I think, part of the reason why they were so intent on demonstrating that while it may look like they were operating at a deficit in terms of technology and techniques, that that disadvantage was offset by the advantages of where they were located and their experience doing virus research, the fact that they've been doing this kind of research for decades already.

Mia Levenson: I wanna talk a bit about your methodology, because you've been talking about spending time in the archives. You've talked about the, the records you've looked at. You haven't talked yet about the oral history that you've conducted as part of this work. And I'd love to hear a bit about both the experience you had with your interlocutors and also how you came to this mixed method research.

Julia Cummiskey: Yeah. Um, oral history is amazing. It was something that it took me a while to get comfortable doing, and I still [00:27:00] struggle with it. I, I hate the sound of my own voice. So this is exhibit A, but, um there's something really scary in some ways about writing histories of people who are going to read what you write.

But it's amazing to actually be able to ask the people who were there the questions that you have instead of trying to read between the lines of what they wrote or extrapolate from the published material or the archival documents. I mean, to be able to just go to these researchers and say, "I saw you wrote this, and then I see this and I just, I can't quite figure out how you got from here to there. Could you tell me?" And then have them tell you. I mean, it's amazing.

I was really fortunate, so when you asked about how the project came about, one thing that I, that I probably should have mentioned is that I was doing the work as a doctoral student at Johns Hopkins University. And there are a lot of projects, particularly in the School of Public Health and the School of Medicine today at Johns Hopkins that are done in partnership with researchers based at the UVRI, in the Rakai Health Sciences program and at Makerere University.

And so I had kind of an in, um, and I was, that was really helpful to me in [00:28:00] terms of just getting introductions to people. I think it also helped that I had an MPH, um, so I was seen as. I was still seen as an outsider. I mean, I'm not a virologist, I'm not an epidemiologist. I have not done a regression analysis in many years.

But I think it was reassuring in some ways to people that that was knowledge and training I had found valuable and that I spoke some of the same language.

So methodology wise, I mean, I had to do I had to use different methods because if I wanted to tell a story that started in 1936 and went almost to the present, there was no kind of sources that would cover that whole period.

The archives are really uneven. The Rockefeller Foundation for all its sins kept amazing records. And again, there's very good scholarship on the strengths of that, but also the ways in which they're, they're very, uh, effective and strategic record keeping has allowed their narrative of the history of international health to really become the [00:29:00] narrative of the history of international.

But the Rockefeller Archive Center in New York is just one of the most fantastic places, and I cannot say enough about how great they are.

Mia Levenson: Shout out to them. I've been there as well. The librarians there are great, fantastic collection.

Julia Cummiskey: Absolutely phenomenal. Could not have gotten this project off the ground without them.

So they have the diaries of the, the IHD officers who were in Entebbe. They have correspondence. They have reports and they required all kinds of reporting. They required daily diary entries from their officers. And so, I mean, that was like almost too much information. But of course it was information created by a particular kind of person for a particular kind of audience.

I had to really read, as we would say, against the grain to try to figure out what, what was going on? What did this look like from the perspective of the people living in the places where they were doing the research? What was the experience and the contribution of all of the Ugandan so-called unskilled laborers or [00:30:00] technicians who were instrumental in producing this knowledge but were not seen or documented as scientists?

But it, there was a lot there. After the Rockefeller Foundation was no longer a partner in this institute, then the archive shifts more to the UK government archives. And then after 1962, there's a lot less in the UK National archives 'cause uganda was no longer, um, a colonial protectorate. And the archives in the National archives in Uganda had very little material on the institute. And the archives tended to be less centralized. So there were a couple things. I was able to track down archives where individual scientists had deposited papers in Glasgow and London, um, and in some other places.

But for the period of the sixties and the seventies, I was relying a lot on published sources and the archives of the institute itself, which luckily they have [00:31:00] saved, despite the fact that in many periods between 1962 in the present, they were under enormous strain. Particularly in the periods of civil war there were effectively no resources going into the institute. Um, only a skeleton staff of people and, um, people that were really dedicated to it, kept it safe, but they, they safeguarded among other things, the contents of this archive. So that was really important. But I was also, I knew I was missing a lot. Now, I'm sure I was missing a lot from the 1930s too, but I can't interview those people.

I did get to interview the son of Alec Haddow, which was very cool. Um, he remembered a little bit about growing up there. But there are people that I was able to meet and interview who were working, um, who were young scientists in the 1960s at the institute. And that was amazing. And, you know, their recollection of what was happening often gave me insight into what didn't make it into the written records, or what I wouldn't have noticed in the written records if they hadn't pointed out to me how significant that was for them.[00:32:00]

Now when you're talking about the HIV and AIDS work, nearly all of the people that were key players in that research are living, and I, I, I am forever indebted to them for their generosity and their collegiality and their willingness to talk about this work, which I think was especially generous given that they are, you know, their careers are on the line.

These are people that are still doing research in many cases and you know, arguably don't have much to gain from talking to a historian. But they were wonderful and I think one of the things that I was able to do with them, and I'm really proud of with these oral histories, is with the permission of the interviewees, I was able to record these interviews, transcribe these interviews, and deposit the transcripts of these interviews both in the United States and in Uganda, so that other researchers who again, come to this story with a different perspective, will be able to take advantage of that, you know, 20, 30, 40 years from now. And so there are now, thanks to the generosity of, of [00:33:00] these interlocutors, there are now records of the kinds of stories that we don't have records for from an earlier period of people, you know, describing some of this day-to-day activity, what it was like to be somebody who had grown up in the communities where this research is being done, what it's like to go from being a child in a community, watching the AIDS epidemic unfold to being a trainee doctor, to being a member of this major research project to being a senior scientist. And that's really, I'm really proud of that and really grateful to the people that that participated in it.

Richard Del Rio: So what, when we talk about independent Africa, a lot of historians are familiar with it as being, you know, there being throughout the continent of different hotspots of geopolitical competition.

Right. During the Cold War, today in the 21st century, we see it as a hotspot for economic competition, different powers, investing in [00:34:00] infrastructure. I would love to hear your view of the kind of trajectory and shape of what you describe as competition for research in Africa.

Julia Cummiskey: Yeah. When you first said Africa, when we think of Africa as as having hotspots, I thought you were going somewhere else with that question, which was like, hotspots for disease and I'm, I'm gonna hijack this question for just a moment because there's

Richard Del Rio: Please do.

Julia Cummiskey: Um, one of the questions that, that I got asked frequently when I was embarking on this project in which, which researchers in Uganda get asked all the time is, why are there so many viruses in Uganda and, you know, why is it such a hotspot for viruses?

And there are all kinds of explanations you'll read. I mean, it does have a very particular set of ecological characteristics, which, you know, you could say are conducive to, an abundant diversity of evolutionary developments, yada, yada, yada. But my favorite explanation is the one that David Serwadda gave me once when I was talking to him, and he said, people always ask why are there so many viruses from Uganda? And he says, because we've been looking for them in Uganda for a hundred years. [00:35:00]

Richard Del Rio: Huh!

Julia Cummiskey: You know, there's been a place identifying viruses in Uganda since 1936. There are not a lot of places where that's the case. Um, and so I do think a lot of our perception of Uganda in particular, and Africa in general, as as a place where you find a lot of diseases, it's not entirely explained by, but there's a big part of it is just, well, where have we looked for them?

But to your question about competition for research. I think one of the things that I found really interesting, deliberately trying to situate this work in Entebbe and from the perspective of what was happening in Entebbe is that that's really not how it looked or felt to people in Entebbe. Their experience of it is much more, they have a research agenda, which in most cases, you know, for the people that I was able to actually speak with, is very much informed by what they think are the most urgent challenges for people living in Uganda. What are the things that are preventing Ugandans from having healthy long lives? And then how [00:36:00] do they identify partners who can bring to that research resources that they don't have in Uganda, and how do they establish the value of that for those partners?

Richard Del Rio: Now, unfortunately, we're approaching the end of our time together, but I have to ask: who is this book for? Who should be reading this book? Now, I understand there's a business of publications, right? And we want everyone to read the book. But in your view, the author, who really needs to read this book.

Julia Cummiskey: When I was writing this book, I had a few different audiences in mind.

But the one that I was most interested in reaching, and, and, and the reason I was so happy to get put in this particular series at Ohio University Press, which is, um, "Perspectives on Global Health", um, because the whole series is really aimed at people that are training to or building careers in global health. What do they need to know in order to do their what they're doing? I think global health is so important, and as a historian of medicine [00:37:00] and public health, I came to this field because I believed and believe that better understanding of how we've done this work in the past can help us do it better in the present, in the future.

And so the people that I most hope will be able to read the book and derive some value from it are people that are going into that kind of work. I also, I wrote the book hoping that it would speak to people that know Uganda and know Ugandan history, whether it's because they grew up in Uganda or they've been working in Uganda for years, as well as people who could not find Uganda on a map. And those are very different audiences, but I, I tried really hard to write a book that, that would be accessible to both those groups of people and meaningful and ring true. Um, so I would say that's, that was my goal.

Richard Del Rio: So all you public health folks go out and buy that book and read it. We need more scholarship on this subject. But, but you know what, we should really find out what are you doing next? What is your next project?

Julia Cummiskey: Thanks so much for asking. Um I'm still in the very early stages, so still, still kind of [00:38:00] trying to get my hands around what it looks like. I want to write a history of health communication in East Africa and modern East Africa. Um, towards the end of the research, well, towards the end of the period that I researched for this book, I was able to see a lot of the work that's going into trying to communicate messaging about HIV prevention in East Africa.

And then as I was writing the book, there was the Covid-19 pandemic as I was, as I was revising the dissertation and, and preparing to to publish it as a book. And of course, you know, just ongoing conversations about how do we talk about risk, how do we talk about risk management? How do we talk about what people should be doing?

How do we establish who is a reliable source of information about public health and, and epidemics in particular? Um, and this real sense that despite the fact that there are now so many places where you can get a degree in health communication. So many independent organizations, nonprofits, for-profit that are [00:39:00] selling their services as health communication experts. There were still, it's still so hard to do effectively, and I started thinking about who else has communicated about health over time, who wouldn't call themselves health communicators, but have in fact been talking about health in all this time in East Africa. And so I'm tentatively calling the project "Speaking of Health," but I'm interested in looking at how different, different kinds of experts have staked a claim to expertise in health communication.

So doctors, marketing professionals, educators, community organizers, religious officials, patients. How have different people staked a claim in this area, and what has that looked like in different periods in East Africa? So I'm hoping that this will be a regional project encompassing Uganda, Tanzania and Kenya.

And so I'm really trying to patch together how much of this is a a national story about Uganda? How much of it is a regional story about East Africa? How much of it is [00:40:00] a a global story about where people earn health communication credentials, and where programs get developed and implemented? So I'm very excited about it.

Mia Levenson: That project sounds absolutely incredible and I'm really excited to see how it develops.

Julia, thank you so much for joining us today. We really, really appreciate it.

Julia Cummiskey: Thanks for having me. This is really a pleasure and I'm, I'm grateful for your time and your, your really thoughtful questions.

Mia Levenson: So again, for our listeners, go out and get Julia's book "Virus Research in 20th Century Uganda: Between Local and Global." Julia, thank you so much for being here.

Julia Cummiskey: Thank you so much, Mia and Richard..