About my dream, my life and HIV

I wrote this for Facebook Note, on April 10, 2009, and I highlighted what was important then and still is now:

First, I want to say, that I am a simple person, who wants a simple life, but I do have my dreams.

I have been working with HIV research for five years now. At first, it was more to clinical studies and now my interest is more to the genetic diversity of HIV. Nevertheless, for me it has always been research.

To be honest, my first ‘encounter’ with HIV came merely from practical reason. In order to finish my residency, I had to choose one research subject. Since I was already assigned for specialization in infectious diseases, I had to choose between typhoid fever, dengue, malaria, and HIV. I had high interest in all subjects, however, no one at the department had any study about HIV that time, and we had many HIV patients. My thought was, I could collect my samples quickly, and graduated sooner than scheduled. So I chose HIV.

I got many questions from my colleagues at that time, as HIV had a very bad stigma in Indonesia, since the disease mostly affected drug users and people who went to prostitutes, in other words, these patients ‘deserve’ to get HIV. In some cases, it might be true, but then I met someone, a patient, whose story has always been an inspiration to me. She is a humble and decent woman, married to a man she fell in love with. She did not know that her husband used to be a drug user. And she told me, had she known, she would have married him anyways because he had changed, and everybody deserve a second chance. HIV ‘came’ to their life when she gave birth to a baby boy, He was born with severe fungal infection that only happened to people with severely altered immune system. The baby was tested positive for HIV-1 and naturally, the parents were checked after, and sure enough, both of them were tested positive. She was not highly educated, but she was an intelligent woman. She read about HIV, asked a lot of questions, and when we met, the first thing she said to me was, ‘I am not concern about myself, I am ton therapy, I will live perhaps 20-30 years with HIV drugs. But how about my son? He has to take HIV drugs since he was born, and surely the drugs will become resistant someday, what will happen to him?’ I did not have the answer that time, and that was the point when I started to study about HIV seriously.

When I had a chance to continue my study, I was lucky enough to find a professor whose first question to me was ‘what do you want to do? what study/research do you want to pursue?’ instead of ‘here are the topics of research that we have in this lab, please choose one’. That is the main reason why I chose Iwate Medical University. It was not easy since we had to find a separate grant other than grants from Japan ministry of education for my research, but once I convinced Prof. Sato how important for us in Indonesia to FIRST have a basic data about molecular epidemiology above all, he helped me to find the grant, and we were lucky that Imai Yasutaru AIDS memorial foundation was willing to give me the grant for the first year. After that, fortune continued to happen, for the second and third year, we got the grant from Japan Ministry of Education.

This work might be simple and doesn’t mean anything for many people, but this why it is important to me: Indonesia has always been a ‘missing link’ when it comes to study about HIV epidemiology evolution in South East Asia or Asia. The previous data only involved less than 20 subjects, and the data was so old, and irrelevant to the current situation. The increasing number of HIV patients has reached a terrifying point, and that includes babies who were born from HIV-positive parents. All studies about epidemiology evolution, basic strategy on HIV prevention always based on data from Thailand, Singapore, Malaysia, Myanmar, etc, and when it comes to Indonesia, it always based on ‘assumption’ that the situation is similar to those in Malaysia/Thailand. WHO/government program on free anti-HIV drug also based on this assumption. We did not know what anti-HIV drugs are already resistant, we do not know what kind of mutation has occurred among Indonesian patients.

So, I am doing what I am doing right now. When I read the article about HIV in Asia, and read a paragraph that said ‘in Indonesia, mostly it was CRF01/AE subtype followed by B subtype. And now I know, how wrong they are. We, in Indonesia have much bigger problem, since I found new HIV mutants (recombinant) and sure enough, the number is bigger than the original subtype B. It will take a lot of work and time to fully map these new recombinant, and there is nothing I want to do more than to finish this work. I feel I need to continue this study, and I need to finish my study about genetic mutation that is related to anti-HIV resistance in Indonesia.

Why am I writing this?

I write this because since my graduation, I have been faced with questions and suggestions about what I should do next. And what made me concern is because many of those suggestions come from people who care about me. Care about my future. And in a way, they are right. I have relatively more secure job if I go back to Indonesia and apply for a position at the University of Indonesia, and go back to practicing medicine. Of course, the money will be much better. I am also concern when someone puts it as ‘you should come back, because the University of Indonesia calls you’.

The thing is, I don’t like practicing medicine, especially at the private hospitals (I like the money though, haha..), and I am not that good in communicating with patients which is important in practicing medicine. I am good at working at the lab, I love being surrounded by machines, designing new experiments, analyzing, finding a conclusion. Writing the paper is a pain in the a**, but every time I go to a conference far far away, and talk to people from WHO, NIH, and have a discussion with them and inform them about ‘hey, this is what is happening in Indonesia (in the genetic perspective), and made them listen to me, I feel… happy. And satisfied, and it makes me want to do more. In my own selfish opinion, I feel like if I am staying and complete my study here, I will have a better contribution to them. But that might be my own selfish opinion.

Another selfish reason is, I like it here. I like living my life here. I like living simply and humbly. I like not having to have car and can bike or walk or take the bus to go everywhere. I like the feeling that I don’t care for luxurious stuff anymore, I love being able to go outside and walk around in a sunny day. I like my friends, and simple things we do together. I like my colleagues, I like how they appreciate my work, my effort, and how they give such a great respect to me, despite my nationality, my age, and the fact that I am still a ‘junior’ in a research world. And moreover, I LOVE my work, I love working and learning about molecular genetic, how a simple sequence of bases can determine the whole phenotype. How ingenious the Power behind all this concept. I like going home after work and feeling like I have done something for a lot of people. If I can, I want to study and work in this field for the rest of my life.

It is not easy, especially since now, I do not have any student scholarship anymore, I have to work my part time every Saturday to support my life, and live on my savings for the moment. I am applying for a post-doctoral fellowship, but there is a chance that I won’t get it, but I want to try anyways. I do like having money, but I have come to a point when I think that as long as I have enough to live a comfortable life, and enough to save for emergency and the future, then I don’t need more than what I just need. A bigger income is not relevant anymore. If I can get more, that’s nice. If I can not, I am happy with that too.

And no, I don’t have any plan on living in Japan for the rest of my life. For now, I just want to finish my current work on HIV molecular in Indonesia. Stay here for another year or two, finish this work, then (if I have a power and chance to choose about what I want to do with my life), after this work, I want to pursue my other dream. First, I want to go to Africa and work with MSF, after that, I want to work in a research center where I can do more work and study more about retrovirus genetic diversity.

I know it doesn’t make sense for me to let go of a secure job and opportunity back home, and choose to live in a situation where I can not be sure about what is going to happen next. And I am concern about that too, along with my concern about how I ‘owe’ these people back home and feel whether I should feel obliged to do what they want me to do. And these people are not just ‘some’ people. They are great people who truly care about me, I do believe that.

However, once again, I am just a simple person, who want a simple life, and I am truly happy with my life and my work right now. I feel like I should do what people back home want me to do, but at the same time, I still feel that I have an obligation to finish my work right now, provide sufficient data on HIV epidemiology molecular in Indonesia, make sure that the future policy, vaccine development, anti-HIV drug policy, can include the data from the Indonesian patients.

And last but not least, should I have an obligation to myself too? to my happiness?

Many things has happened since I wrote the note. I didn’t get the scholarship for the following year after my graduation, so I had to do my post-doctoral work without any financial support for a year. However, there is always a silver lining, even when we didn’t expect any. I got help, not from the people I was expecting help from, but from other people (bless them) friends, colleagues, who believed in me and believed in my dreams. I finished the near-full length genomic sequence for the Indonesian Variant of  a strain of HIV during my post-doctoral period. And in the following fiscal year, blessing after blessing came straight from above :p (Yeah, straight from above as never in my wildest dream I would’ve thought that I could end up this happy).

I published one paper about the genetic diversity among Indonesian HIV patients, and one paper about the Indonesian variant of HIV recombinant. I am writing another paper at the moment, about Drug-related HIV mutation.

And now, I am still doing research, still thinking (even though I am still living in Japan), I don’t see myself living in this country for the rest of my life, but most importantly, still as happy as I can be. I am working on Influenza vaccine project now. But that, is another story for another time.



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