Running a clinical research team is a complex progress, but seeing the team come to life must be an amazing experience. In this edition of Meet The Lab, we are visiting Professor Catriona Waitt and her team to learn about her experience in establishing her research group at the University of Liverpool and Infectious Diseases Institute, Makerere University, Uganda. Thank you very much for joining us today, Prof. Waitt!
Can you tell us about MILK and At the EQUATOR?
MILK is the Maternal and Infant Lactation pharmacoKinetics programme, which was my Wellcome Clinical Research Career Development award which I started in 2015 after a pilot on an Academy of Medical Sciences Starter Grant. In MILK, we have evaluated the transfer of drugs for HIV, TB and malaria from mother to breastfed infant in Uganda. We have recently secured more funding and will look at other classes of drugs over the next five years.
Alongside this, we established the ATtaining EQUity of Access TO Research (At The EQUATOR) public engagement programme with Wellcome funding. This has aimed to ensure meaningful integration of community engagement and involvement at all stages of research.
What is the general structure of your team? When was the team created?
I have been living and working in Uganda since 2014, exploring the safety and exposure of drugs in breastfeeding mother-infant pairs (e.g. antiretrovirals, TB drugs, anti-malarials). The team started with myself, a junior doctor, two research nurses, lab runner and technologist. Some of these roles were shared between different but related research projects. Further Wellcome funding in 2021 allowed me to expand my team to include a dedicated public engagement officer, and a peer mother, who is a young woman living with HIV and has delivered as well as breastfed four children whilst on anti-retrovirals.
The Uganda Chapter of Pharmacometrics Africa working together.
This key pair have supported the expansion of our public engagement work. In 2021, I appointed my first two postdoctoral pharmacokinetic modellers in Uganda, and their role supported the inception of the Uganda Chapter of Pharmacometrics Africa. My research nurse from 2014 obtained her Masters in Clinical Trials via an EDCTP-funded project I led, and is now undertaking her PhD with the MILK team. We also welcomed two more PhD students to bring physiologically based pharmacokinetic modelling into the team, funded by the Bill & Melinda Gates Foundation. It is exciting to see the team grow and becoming the vibrant, multi-disciplinary group. Our team reflects the diversity of the populations we seek to study, including several nationalities as well as male and female which can be unusual in some African settings.
What are some of the most surprising things you have learnt while setting up your team?
I should not be surprised by this: every single individual brings something unique and of great value to the team. By flattening hierarchies and encouraging different team members to chair our meetings, some wonderful perspectives and solutions have come from all angles. For example, we were able to (1) amend a study protocol in response to questions from the lab runner (a Ugandan role), (2) have our peer mother and lab runner co-author publications, and (3) have the postdoctoral pharmacokinetic modellers lead community engagement events under mango trees in remote villages.
I love providing people with the space to step outside the comfort zone and try something new, and at the same time I can recognise and respond to training needs. My team members are all confident and increasingly well-rounded, and I believe set to make an impact. I envision several of them as future research leaders.
Do you think formal management training is important for starting a research team?
There is an important distinction between leadership and management, but training in both is important, especially for those who don’t see themselves as natural leaders or lack confidence to apply their skills and stretch themselves. I wish I had access to such training at an earlier stage, and I continue to take every opportunity to attend trainings, listen to leadership podcasts and read (I am always looking for recommendations from those whose leadership I most respect).
How diverse are the projects in the lab? Are researchers working on projects in team or individually? How do you stay up-to-date with everything happening across the group?
I believe in creating a strong sense of team. Although we primarily work on the MILK and At The EQUATOR projects, I encourage my team members to explore additional funding and build their own interests which may be slightly different. This is important to ensure the future relevance of the group, responding to locally relevant questions. Our overall theme relates to equity of access to research, with a focus on complex and under-studied populations. Hence, this leaves plenty of leeway as to which aspects to research. Each specific project is led by one individual and supported by the wider team.
Both post-doctoral pharmacokinetic modellers are employed on our team at 50% to enable them to serve in diverse teaching roles, consultancy and embrace additional training opportunities and collaborations, and this flexibility has brought added strength to the team.
We keep up to date with a weekly team meetings with a rolling agenda where each subgroup (clinical, laboratory, pharmacometrics, public engagement, studentships, future opportunities, key collaborations) has time to present. We have specific weekly modelling calls and a hands-on practical ‘lab meeting’. As the team builds, I anticipate having additional specific regular meetings. Between this, we use several different WhatsApp groups to discuss emerging questions, key updates and additional business.
How do you motivate your team members?
I believe motivation comes from feeling you are a valued member of the team, your opinion matters, that you are given the necessary training and environment to conduct your work to the best of your ability. We have weekly full team meetings and separate pharmacokinetic modelling meetings, and regular community and stakeholder events that bring the team together. During these, there is often the opportunity to network with one another in a more informal environment, sometimes coming to understand a different cultural perspective (Uganda is extremely diverse with 56 tribes and 40 spoken languages, and team members hail from different parts of the country).
How did you develop the international visibility of your lab? Was social media important?
Inclusivity and diversity is at the centre of everything we do.
My work has always had an international focus, with partnerships between groups in the UK, Uganda, Malawi and South Africa primarily, but with collaborators in many countries including Kenya, Tanzania, Zimbabwe, the USA, Canada, Sweden, the Netherlands, Germany, France, Switzerland, Italy, Thailand and others.
However, I also have embraced opportunity to serve on international committees and working groups, for example with the WHO, the International Society of Pharmacometrics, Pharmacometrics Africa etc. I have also co-authored several reviews and perspective pieces which have highlighted the huge gaps in evidence for the populations we study, and these have been well cited.
Another tip is that if you are ever invited to give a talk, remember that more people may listen to that talk than read your papers. So put the same time, effort and preparation into that talk as you would a publication. Invitations to talk (including prize presentations to BPS in 2021 and ASCPT in 2024) have also opened some exciting opportunities for our group.
Social media is important for visibility. Partner organisations, funders, committees, and communities may be more likely to see short summaries on social media than read scientific papers. It is important to develop a strategy, decide what you will post on and how often, and build the online communities by interacting with the posts of others. Having a dedicated public engagement officer on our team has been an asset, and we have explored a range of creative approaches to making our work more accessible including work with a local film crew. Many of these videos are on our YouTube channel.
In this video, Catriona talks us through a day in her life as a clinical pharmacologist.
What would be your biggest piece of advice for newly starting investigators on securing a fellowship and running a successful lab?
Find an idea that you are really excited about, that you cannot let go of, that you don’t feel as though you can rest until you solve. Through my own experiences of pregnancy and breastfeeding, alongside many complications and challenges in my children’s health as well as mine, I felt extremely frustrated by the complete lack of informative data, and the disempowerment I felt when I sought answers. I realised that with my skills in pharmacology, I could be part of the solution – and therefore in the dual role as researcher and community member, I feel inspired to keep going, overcome the obstacles and make a difference.
When writing applications – read the fine print and write in a way that answers the questions posed. Structure your work and use subheadings. Ask colleagues to peer review it. Take every opportunity to discuss your ideas in a group at an early stage – we have specific meetings to enable the early presentation of ideas in quite a raw stage because of the value in doing so. If you are invited to an interview, practice as much as you can and try and get colleagues to form a mock panel.
When you get started – try not to be distracted by all the demands on your time. Find the time of day when you work most productively and fiercely protect that time to do the work of greatest value to you. It can be easy to use your best time to do administrative tasks that can wait.
When you get discouraged, remember how far you have come. Remember your purpose – if you don’t have a ‘mission statement’ for the project, get one. Remember why this work is important and will make a difference. Seek out mentors (often informal ones are the best). Build peer support groups – you will find other new investigators are facing just the same challenges.
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