Julie SG. Papango, MLS(ASCPi)CM is a medical technologist currently working in Albany Medical Center in Albany, NY. She was born and raised in the Philippines, where she trained as a medical technologist. I had the pleasure of talking with Julie recently as I had read about her extensive work in global health through Doctors Without Borders which was highlighted by ASCP when they designated her as a Top 5 honoree of the prestigious 40 under Forty recognition program in 2019.
I was impressed by the extent of her work before talking with her, but after digging in and hearing the details, I was entirely blown away and fell nearly speechless. Julie is truly the bravest person I have ever met. She has spent years of her life serving in some of the world’s most difficult places and has done so seeking no reward. One can only imagine the kind of daily challenges that would arise working in these conditions. Not only that, but Julie has done all of this while transitioning as a person of transgender experience. Knowing that in some countries this has been met by death, Julie chose to serve those in desperate need anyway. Take a moment to really digest that. Her bravery and dedication to humanity goes beyond anything most of us will ever hope to parallel.
I hope you enjoy reading about her contributions to the world and are left inspired to make your own contributions too!
Q: What made you interested in global health and how did you have the idea to work with Doctors Without Borders?
A: After graduating as a medical technologist in 2003, I had a very vague idea about working in global health inspired by what I had seen portrayed in movies. My ideas were almost romantic as I pictured myself working with people in need. I heard of Doctors Without Borders around 2005 and thought this might be a good avenue to work through. The idea became more solidified in mid-2007 when I heard a former colleague of mine speak about his experiences working with them around the world. I was so inspired by his impact and realized that I could make my dream a reality. I immediately applied and went through their lengthy interview process and was accepted in December 2007. Although I was matched to a project early the next year, I was not able to go as I stayed back to take care of my mother who had become very ill at the same time. Once she became stable, I re-volunteered and went through the process again and finally started out in my first project in 2009.
Q: Can you tell me about your time working with Doctors Without Borders?
A: The first project I was matched to was in the Kampong Cham province in Cambodia. I spent one year and two months there to help the Ministry of Health improve their tuberculosis detection program and set up a lab for diagnosis with bacterial liquid culture. This was challenging because there were no public laboratories performing these tests at the time and we started from scratch. I worked to train the local workforce to function as medical technologists and to take over and expand the project. At the time, it was challenging for Doctors Without Borders to fulfill their mission to improve the laboratory services because there are not a lot of medical laboratory technicians working as volunteers. Many laboratory members just don’t realize there is a real need and opportunity to work in this capacity. I was originally supposed to stay only for six months but extended my stay because they weren’t able to find a replacement for me for another eight months.
After this, I returned home for a short time when I was then contacted to work in a town called Arua in Uganda in 2010. Admittedly, I was scared to go to Uganda because there had been open hostility towards the LGBT community there, and an activist of homosexual orientation had been killed in his own home there recently. I am a person of transgender experience so this was frightening for me. But I decided to push forward because there was an increasing incidence of HIV/AIDS and the laboratories that were in existence needed serious quality improvement to properly perform testing. For six months, I served as a laboratory supervisor and worked to bring the testing standards up to par.
My next time working with Doctors Without Borders was in October of 2012 when I spent six months working in an extremely remote setting of Papua New Guinea. I spent my time there on the island of Bougainville which hosted only 6 non-native persons in the entire town of Buin where I worked. Transportation across the island was a full twelve-hour trip, which meant crossing numerous rivers and very rough roads. The project focused on maternal and child health, and I was there to help improve the laboratory which was manned by just one technician, who had received the entirety of his training on-the-job without a formal degree. When I arrived, the lab looked like nothing more than a stock room. I spent two weeks alone just cleaning! Eventually, we were able to set up a basic functioning laboratory offering rapid testing for HIV, HCV, syphilis, as well as microscopy, blood counts, and basic transfusion services.
After this, in August of 2013, I was recruited to work in South Sudan for an emergency project. Sudan had split into two countries in 2011 and there was conflict in the Nuba mountain border area over oil land ownership. This created a refugee crisis which resulted in 60,000 refugees rapidly fleeing the area and were forced to live in camps. There were major issues with child mortality due to malnutrition, cholera, meningitis, and malaria. Doctors Without Borders was in the camp and set up a tent that served as part hospital, part living quarters for us working there. The living quarter capacity was meant for just 6 people as there was already a team there, but out of necessity was shared among 30. This situation was challenging, as food and water were very limited – for a camp population of this size, there were only three water points in the entire makeshift facility. Working in this setting is known among the volunteers as the “true litmus test” due to its extreme challenges. My role there was to set up the tent in which we would run the laboratory, help train local staff, and to set up the point of care and basic blood testing for transfusion services. With a break in between, I spent a total of almost two months in the camp working on this project before returning home for a month or two. After this, I returned to work again in South Sudan because there was a need to verify the accuracy and quality of the testing that was being performed in the refugee camp. There were many issues with transporting the specimens to referral labs, and we wanted to analyze if these samples were being handled appropriately to yield reliable results. This is one of the frustrating things about working in these situations, nothing is done perfectly, and you have to find a way to make it work. I was scheduled to work there for four months but after month three, all non-essential Doctors Without Borders staff had to be evacuated out due to a civil war that broke out and made the region too dangerous.
I was then supposed to go to Ethiopia to spend a month working on a primary care health project. I was delayed because of a visa issue pertaining to the fact that I was transgender. The difference between how I appeared on the outside as female and what my passport showed as male was an issue. Eventually, after returning to the embassy every day for a week, I was denied a visa. I was given an invalid reason and I knew that this was just a power-play and was really due to the fact that I was of transgender experience. Eventually, after more paperwork and delay, I made it through the process and worked in Ethiopia for a month to perform a quality analysis on the basic laboratory testing and ensure an adequate chain of supplies that had been initiated by Doctors Without Borders before passing it on to the Ministry of Health. Being there for only a month was frustrating because there were still more gaps to fill, and there was only so much I could do. This is just the reality of the situation and you have to accept that it is not always perfect.
After settling in back home in the Philippines for a short time, I felt that I wanted to return to Cambodia to continue the work that I had started there. So, in March of 2013, I went back to work in the laboratory that I had helped start. This time the laboratory had expanded to other sites where more advanced tuberculosis testing was being done and the government was increasing the support for the labs. I worked in quality improvement and helped to create a network for transporting specimens to larger referral laboratories. At the end of my stay in November 2015, we were able to finish the project, donate all of the equipment that had been provided by Doctors Without Borders, and hand the reigns over to the Ministry of Health. I decided at this time that I would look to stay in the country and worked as a private citizen in a developmental aid project, which was aimed to improve the country’s diagnostic microbiology services. There I found the organization called Diagnostic Microbiology Development Program. This was an interesting shift from the humanitarian aid work that I had done with Doctors Without Borders since it focused more on sustainability rather than immediate intervention in a crisis.
Q: What brought you to the US?
A: Over the years of volunteering abroad, I have had countless challenges when I am crossing a border and the fact that my external appearance of a woman does not match the gender marker that is designated on my passport. I decided that it had come time to go through the process of rectifying this situation and so I applied for a visa to work in the US with the eventual goal to change my gender marker on my passport. I moved to the US in 2016 and have been working as medical technologist in Albany since.
Q: I know that working in global health can sometimes be equally as challenging as it is rewarding, and you have certainly faced your fair share of challenges. What would you say to those wondering if they have what it takes to contribute?
A: I encourage people to go out of their comfort zones and look at what you can give, and just give it. It can be scary, but we have a responsibility to the global world to share what we are privileged to have. For me, being a person of transgender experience, labels are assigned to me that this is not the “right type” of work for me, that I might be more suited for the fashion and beauty industry for instance. This is like any stereotype that puts people in boxes based off race, gender, religion, or sexual orientation. This box should not be the reality, and at the end of the day, we must realize that we are not boxes and we are all just human beyond labels. I encourage everyone to break the glass ceiling, get out of their comfort zones and look for ways to share what you have with the world.
-Dana Razzano, MD is a former Chief Resident in her fourth year in anatomic and clinical pathology at New York Medical College at Westchester Medical Center and will be starting her fellowship in Cytopathology at Yale University in 2020. She is passionate about global health and bringing pathology and laboratory medicine services to low and middle income countries. She was a top 5 honoree in ASCP’s Forty Under 40 in 2018 and was named to The Pathologist’s Power List of 2018 and 2019. Follow Dr. Razzano on twitter @Dr_DR_Cells.