When African professionals migrate to the United States or Europe, their departure is often
thought of as "brain drain." In the world of research ethics, at least one training program is causing
the opposite effect. The Johns Hopkins Fogarty African Research Ethics Training Program, now
entering its eighth year of operation, is the subject of a sweeping new case study published in the
July issue of Academic Medicine. The study reveals for the first time some potent lessons in what it
takes to deliver a successful cross-cultural ethics training program.
"We initially sought to increase the critical mass of African individuals professionally trained in
ethics," said program director Nancy Kass, deputy director for public health at the Johns Hopkins
Berman Institute of Bioethics, "but it also turns out that our trainees are making institutional changes
to policies, drafting new guidelines and generally raising awareness of the need to support research
ethics. And some trainees are not just doing these things in their home countries but throughout the
continent."
In a region devastated by the HIV/AIDS epidemic, the trainees provide encouraging evidence
of success in the global effort to work collaboratively with African professionals to develop their own
ethics-based research methods.
After studying in Baltimore for six months under the supervision of a mentor with similar
research interests, trainees return to Africa to begin a six-month practicum on the topic of their
choice related to the ethics of research. One trainee returned to Zimbabwe, eager to share his
newfound expertise at more than 30 workshops in surrounding regions. Another returned to the
Democratic Republic of Congo and established two institutional review boards. Yet another helped
design international guidelines for HIV vaccines.
"During the practicum, trainees implement all they have learned in the classroom," said Adnan
Hyder, the program's co-director and an associate professor of international health at the Johns
Hopkins Bloomberg School of Public Health. "The last half of the program attempts to mitigate a
familiar problem for researchers in Africa: trying to borrow principles of ethical review from
developed countries. Instead, trainees contribute to the research ethics capacity of their home
country by setting the agenda themselves. The process transforms students into effective
researchers and advocates for the kind of research ethics that will actually work in their own
countries."
The case study reveals that Johns Hopkins Fogarty Bioethics trainees return to Africa well
equipped for the practicum and subsequent work. While at Johns Hopkins, trainees attend three
intensive courses, multiple seminars and regular one-on-one mentoring sessions, as well as IRB
meetings at the university and at the National Institutes of Health.
Despite considerable success stories, the program still faces challenges. The Academic
Medicine article demonstrates the importance of maintaining regular contact with trainees upon their
return home, particularly as many of them then face other professional demands; in four years, the
program lost contact with only one trainee. The program's directors have also learned to require
monthly progress reports and to finance each practicum in stages to ensure timely completion.
Backgrounds of those who have gone through the program to date have varied; the 23 former
trainees include a philosophy professor from West Africa, a pediatrician who works with orphans, an
adviser to the Cameroon military, two IRB coordinators and a staff member of an HIV vaccine-ethics
group.
In 2000, the Fogarty International Center of the NIH established the International Bioethics
Education and Career Development Award to improve the quality of international ethics training, with
a special focus on training for professionals from developing countries. Johns Hopkins was one of five
institutions in North America selected to help launch the initiative, and selected Africa as its area of
focus; three to five scientists from sub-Saharan Africa have participated each year.
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