Dr. Nance Cunningham was sure she was finished with university after getting her Master of Health Science degree. She worked in global health and civilian protection until she was met with one particular project on hepatitis C (HCV) case-finding and treatment, a project that would blossom into one of her passions.
While HCV carries a high burden of illness and mortality, it can be cured if identified in time, providing the potential to eliminate it as a global disease of concern, if enough people get access to treatment. This knowledge stayed in the back of her mind once the contract was completed. A poet and friend of Cunningham had died in their 40s from HCV without knowing they had it until it was too late.
At that point, she was determined to uncover why people were still dying from this infection and what more could be done to prevent it. An application to the University of British Columbia (UBC) for a PhD in Experimental Medicine was accepted under Dr. Viviane Lima’s supervision, prompting her move from Yangon, Myanmar to Vancouver, BC.
However, the COVID-19 pandemic had begun right as Dr. Cunningham was about to submit her thesis proposal. Initially, the plan was to use national survey and census data examining Asia’s HCV patterns in relation to BC’s epidemic, but she pivoted to an entirely different concept where she could collect data on her own. Having made a few contacts within BC’s hepatitis community already, she was able to incorporate the concerns of those folks into a partnership and research project while also connecting with her second supervisor, Dr. Kate Salters. This culminated in Dr. Cunningham focusing her thesis on access to HCV treatment in BC for individuals with histories of drug use or sex work, knowing that those with these histories are more prone to HCV exposures for fear of disclosure with their doctors.
Cunningham’s research was made up of conversations with potential patients who had a history of drug use or sex work, along with primary care practitioners who might treat them. These conversations brought forward insights that helped inform her research further as “people from these communities were very generous with their time, stories, and insights,” she said.
In the end, Dr. Cunningham found that a major barrier to receiving care was stigma. The act of outwardly demonstrating respect played a large factor to overcoming that, but healthcare practitioners were not fully understanding how best to handle stigma despite understanding it as a large issue. The difference in perspectives created misunderstandings that made diagnosis and treatment for HCV less likely, even with the best intentions to help. Not only did she present her findings as research, she also sought out to create a professional development module based on it, so healthcare professionals can take the course for credits to maintain their licenses.
With a PhD under her belt now, Dr. Cunningham is headed back to Myanmar living between other postings. Ideally, her work will continue to help with the elimination of viral hepatitis and she has ideas on collaborations to better use routinely collected data to guide and evaluate activities to improve overall health. Dr. Cunningham recognizes that there is a great need for engaging and reliable information on health, so everything she does will also be followed by contextualized health materials that take into account local conditions, resources, and beliefs. Whatever shape this takes, she will approach it with the curiosity and willingness to follow lived experience, that has guided her work to this point.