Nick Janusz
University of Manitoba
Age: 23

I was born in Vancouver, British Columbia, Canada, and completed my Bachelors of Science at the University of Calgary in Calgary, Alberta. My undergraduate studies included a focus in microbial biology, and my senior thesis was spent researching Leishmania aethiopica, which I sought out after spending four months working with L. donovani and L. major. My work in Calgary was extremely satisfying as research experience, but the significance to me of the clinical impact of my research finally convinced me to pursue medicine over a graduate degree.

I moved to Winnipeg, Manitoba, to begin my MD studies at the University of Manitoba. From the outset I was determined to carry my interest in tropical medicine forward from my undergraduate work. I plan to continue to work towards postgraduate training in tropical medicine. I am planning to return to Ethiopia, having been extremely impressed by the challenges present and the eagerness of clinicians within the country to receive outside help to address these problems.

What does winning the Kean Fellowship mean to you personally/professionally?
The Kean Fellowship is the most prestigious award I have received. It is extremely gratifying to have my accomplishments and initiative to-date acknowledged. It is even more rewarding, however, to receive some indication that my goal of a career in tropical medicine is possible, and that I am a good candidate for such a career.

Describe some of your most memorable travel or work experiences.
I had read about cutaneous leishmaniasis for years, since I began researching Leishmania, and had come to think of the natural history of the disease in an almost rote manner: a circular or oval lesion of cutaneous or mucosal tissue, self-limiting and healing without intervention within 2-4 years. However, I had never seen a case in person myself, having never traveled to an endemic country.

My first opportunity to travel came about a week after I landed in Addis Ababa. The town of Siltie, in the Gurage zone, is a recent endemic area for the disease. I was hoping to observe new cases, but there were very few due to high river levels which kept farmers from coming into town.

What I did see were dozens of patients who were either receiving treatment or had been cured. The clinical appearance, however, was nothing like what I expected. Among the extremely heterogeneous 15 or so patients I saw, at least 10 had extensive scar tissue, including two patients with keloid scars spread across much of their faces. These outcomes, I learned, were not due to leishmaniasis, but were the result of “local treatment,” a blanket term for a variety of indigenous health practices, including herbal treatments, western pharmaceuticals administered in inappropriate regimens and heat cautery—the cause of the most dramatic scars I saw that day.

After a few hours spent in a small, one-room clinic in a remote town in Ethiopia, my knowledge of the natural history of a disease, gained from countless hours of literature review, had been totally shaken. The possibility of local treatment had never been discussed in the literature, but I could clearly see that under these circumstances it was the most important factor for outcome, and from talking to patients I realized that the majority of people in the region sought local treatment before accessing any Western medicine.

Although I would come to learn much more about the realities of Leishmaniasis treatment in Ethiopia over the next seven weeks I spent there, and ask many more questions for which the answers have not yet been found, no experience was as singularly momentous as that first experience in the Siltie clinic. I learned that day just how indispensible on the ground knowledge is, especially with medicine in the developing world.

What advice would you give to those just entering school or trying to determine their specialty or field of interest?
Medicine is an incredibly wide-open field, so don't abandon any interest you might hold in favor of medicine. With diligence, most interests can be tailored to fit within your medical training or career.