By Sarah Rapaport ’18

Even before applying to college, I knew that I wanted to study neuroscience, specifically brain injury, because of a personal experience that sparked an ongoing curiosity with pathologies of the mind. As a freshman at Duke, I enrolled in the FOCUS cluster Cognitive Neuroscience and the Law, where I had the privilege of taking courses such as Neuroscience of Language, taught by Dr. Edna Andrews.

The coursework and discussions in Dr. Andrews’ class immediately challenged and broadened my analytical thinking. Initially, I entered neuroscience as a sponge, ready to soak up and accept everything I could to understand why we are the way we are, why injury can change us or wreak havoc on specific functions without touching others or why some people recover after injury while others don’t. An excited and exuberant freshman, I learned from Dr. Andrews that taking information and research at face value can be dangerous. To truly learn, one must read with a critical eye, be wary of convenient solutions that may lack rigorous backing and make sure all the pieces of the story add up. Every class was so eye opening that at the conclusion of the course, I decided to apply to Dr. Andrews’ Bass Connections team, Perception, Language and Memory, to continue to learn through her mentorship.

To truly learn, one must read with a critical eye, be wary of convenient solutions that may lack rigorous backing and make sure all the pieces of the story add up.

The Perception, Language and Memory team had a group component, where we met and discussed research related to the field, as well as an individual component. Although this Bass Connections team represented my first research experience, for the individual portion of our work Dr. Andrews gave me the liberty to choose my own language-related research topic. Naturally, I chose brain injury, which fit well with my FOCUS curriculum. Initially starting with literature reviews of brain injury and language, we decided to look more closely at blast traumatic brain injury and language. However, this topic ultimately evolved to reflect complementary interests that emerged through my participation in another Duke program, DukeEngage.

The summer before joining Bass Connections, I participated in DukeEngage with the Foundation for Sustainable Development (FSD) in Kakamega, Kenya. Both the internship experience and the program director Peter taught me an incredible amount about international development. Similar to what I had learned from Dr. Andrews, Peter emphasized the importance of not taking development research, programs or interventions at face value, but rather to foster awareness and critical thought to evaluate them.

This evaluative and reflective process included being excruciatingly honest about the actual impact of the work, including the ownership and involvement by local communities. It also involved questioning who benefits from interventions and cultivating an awareness of the ethical and paternalistic ambiguities inherent in international development work. We learned first-hand how collaboration and relationship building are vital to the success of any project, particularly in cross-cultural settings, and how immersing oneself in the culture of the host country can aid in this through increasing one’s cultural competency. Finally, we learned that having the willingness to make mistakes while putting these skills into practice, which often resulted in looks of surprise and laughter, often dissolved barriers of perceived differences and led to both productive collaboration and genuine friendships.

My DukeEngage experience sparked an interest in international development as it relates to health. This newfound passion fit the research with Dr. Andrews, so the second part of my Bass project was devoted to investigating brain injury and language in low- and middle-income countries (LMICs). This research yielded insights into epidemiological trends as well as the most impactful interventions in the field and culminated in an 80-page review paper of traumatic brain injury and language in low-, middle- and high-income countries. The group portion of our Bass Connections team culminated in a trip to the Dolphin Research Center in Florida, where we were able to learn first-hand about dolphin cognition, one of the topics we had discussed during the semester.

At the conclusion of my first two years at Duke, a combination of FOCUS, DukeEngage and Bass Connections had catalyzed the development of critical thinking and analysis skills, introduced me to research and deepened my enthusiasm for civic engagement, all practices through which I found meaning and excitement. For the second part of my undergraduate experience, I wanted to find a home at the intersection of these passions – ideally, some area of brain injury research that had a community and cross-cultural component, yet required constant critical thinking to ensure the ethics and validity of the work. I found this home in my second Bass Connections team, Improving Neurosurgery Patient Outcomes in Uganda, which is known in the neuroscience department as the Uganda team for short.

The Uganda Bass Connections team is the undergraduate branch of Duke Global Neurosurgery and Neuroscience (DGNN), an initiative with the mission to promote heath in low- and middle-income countries through a collaborative and evidenced-based approach. DGNN does a variety of work worldwide; however, one of their focuses has been on East Africa and particularly, Uganda. DGNN in Uganda collaborates with Mulago National Referral Hospital (MNRH) and Makerere University and has a variety of initiatives aimed at improving neurosurgical capacity, including a residency training program and an ongoing commitment to integrating modern equipment and aiding in the development of dedicated neurosurgical operating rooms. Our Bass Connections team’s work is aimed at examining the nonsurgical factors that contribute to positive postoperative outcomes.

I wanted to find a home at the intersection of these passions – ideally, some area of brain injury research that had a community and cross-cultural component, yet required constant critical thinking to ensure the ethics and validity of the work.

Our team is broken into three sub-groups that reflect priority areas for postoperative outcomes improvement. There is an infection control team, a patient caretaker education team and a medication management team. Generally, our entire team spends the spring semester evaluating research data, developing interventions in conjunction with our team leader Tony Fuller (one of the founders of DGNN) and our Ugandan colleagues and preparing the necessary documents to spend the summer in Uganda implementing the interventions and conducting research. Then, in the fall, we return to Duke and analyze, present and write up our results.

The fieldwork component of the Uganda team was an incredible opportunity within itself, for it allowed me to put the principles emphasized from DukeEngage into practice again. Through our team’s work, I have continued to learn to effectively collaborate with local professionals, who are experts in their field and community. I have also learned the importance of flexibility, adaptability and creativity, for the way one imagines research or an intervention back home is rarely how it is exactly applied in the field. I’ve also learned the value and responsibility of learning about the host culture and customs, such as through learning some Luganda (a major language in Uganda), which I took the semester before.

Conducting fieldwork internationally affords the opportunity to learn from mentors outside the walls of Duke, people who have grown up in a culture and education system different from ours and thus have had different lived experiences from many at Duke. These international mentors dispensed invaluable knowledge stemming from their perspectives of all things related to our work. This interaction was so valuable, as our team always had a lot to learn from people who have different viewpoints than us.

Another critical component of my DukeEngage and Bass Connections experiences has been reflection. Inherent in any community engagement, especially international work, is the need for open-mindedness and ethical inquiry. This includes the questioning of both oneself and the work – reflecting upon one’s role as an outsider from a country that has its own problems with health inequities, understanding how being a global citizen from a resource rich country affords opportunities to work in a resource poor setting that often are not granted the other way around,and the (sometimes vast) differences between intention and impact. I have also learned that sometimes one’s presence and work can have unintended consequences that need to be considered, discussed and pre-emptively mitigated. One of my favorite parts of my field experiences with my Bass Connections team was the nightly discussions (on our favorite couch) about these various issues. Tony always added incredible insights to these conversations, often stemming from his own extensive experience in the field of global health.

Bass Connections has allowed me to take my pre-existing enthusiasms and delve into them through research that is immediately applicable to the real world. Through Bass Connections, I have found countless opportunities for mentorship, teamwork and reflection, thus laying the groundwork for how I hope to shape a future career in medicine and global health capacity building.

Through Bass Connections, I have found countless opportunities for mentorship, teamwork and reflection, thus laying the groundwork for how I hope to shape a future career in medicine and global health capacity building.

A feeling of profound gratitude for all the opportunities Duke has afforded me, and particularly Bass Connections for supporting my research, has prompted me to join the Bass Connections Student Advisory Council where I can contribute to strengthening the program and expanding it to new student populations at Duke. When talking to prospective students, whom I always strongly encourage to apply to project teams, I find the Bass Connections buzzwords of interdisciplinary, vertical learning and team-oriented research seamlessly roll off my tongue, not because I am told to say them – I’m not! – but because they truly describe the essence of the Bass Connections experience, which has enabled individuals like myself to gain so much.

Learn More

• Read about this year’s project team, Interventions Improving Neurosurgery Patient Outcomes in Uganda.
• Join us at the Bass Connections Showcase on April 18.
• Explore additional Bass Connections projects in the Brain & Society theme.

Photos: Sarah Rapaport and DukeEngage program director, Peter; Sarah (second from right) and her Perception, Language and Memory teammates at the Dolphin Research Center in Florida; Sarah (fourth from left) and Uganda team members and collaborators in Kampala, Uganda; Sarah (right) and Uganda teammates present their poster at a Duke Global Health research event; Sarah (fourth from right) and Uganda team members and collaborators; Sarah (second from left) and Uganda undergraduate team members