‘Teach a man to fish and you feed him for a lifetime’: one alumna’s contribution to global health
Professor Sonia Buist (née Chapman) (MB ChB 1964) is one of the world’s leading experts in chronic obstructive pulmonary disease (COPD). Born in India and educated in Scotland, the US and Canada, she founded the American Thoracic Society’s MECOR programme – which has trained almost 3,000 graduates in epidemiologic, clinical and operations research – before turning her attention to enabling female leadership in healthcare in Africa.
Never let it be said that I have had a dull life. I was born in Naini Tal, India, in the foothills of the Himalayas, where my mother, two brothers and I would go in the hottest months of the year while my father – a Superintendent in the Indian Police Service – stayed in the heat of the plains. These were the waning days of Britain’s power in India.
As the time for the Partition of India and Pakistan approached and the second world war ended, my mother, two brothers and I were sent to the UK where we moved in with my father’s family in the small town of Dollar, in the foothills of the Ochil Hills in Scotland. Luckily for us, that small town had a fantastic school, Dollar Academy, where I received all my pre-university education. My two brothers went on to the University of St Andrews, and I followed in 1958 to study medicine, graduating in 1964.
Sonia at St Andrews
The college of the scarlet gown
St Andrews, and the University, were perfect for me: a walkable town; a relatively small class size; an excellent – and memorable – faculty; a good mixture of studying, games (basketball) and student life. The memories are embedded in my brain: Latin receipts from my Senior Woman and Man on Raisin Monday; being captured on Kate Kennedy night after basketball and transported miles away to a deserted Devon Glen with my team, from where we had to find our way back home; washing my face in the dew in the Castle grass on 1 May; singing in the Chapel Choir led by Cedric Thorpe Davie, followed by the Pier Walk after Sunday Chapel; sloshing my way to class from University Hall on rainy days; the last three years spent studying in Dundee… I could go on. It was a very full, exciting and endlessly challenging life. We wore our scarlet gowns to class and every day – in fact, I didn’t have an overcoat until I went to Dundee for my clinical years.
Across the water
My life changed dramatically when I graduated. I married one of my teachers, Professor Neil Buist, and moved with him to Denver in the US, where he was starting a Fellowship in Paediatric Metabolic Disease at the University of Colorado. I was accepted there to do an internship in General Practice. We had very busy lives, studying and taking advantage of exploring the Rocky Mountains in summer and winter.
Sonia with Professor Neil RM Buist
The next change was a move to Portland, Oregon, on the west coast of the US, where my husband had accepted a position in the Department of Paediatrics to set up a Metabolic Disease Laboratory. I began a Fellowship in Pulmonary Medicine at the Oregon Health and Science University, and we started a family. Life in Portland was busy with challenging careers and three young daughters, but we all thrived and took advantage of everything Oregon had to offer.
One of the mountains close to Portland that played an important role in my career was Mt St Helens which erupted in 1980, covering the northwest with ash. At that point I had spent a year’s sabbatical at McGill University in Montreal, Canada, gaining a Diploma in Epidemiology, and was the only pulmonary specialist in Portland with epidemiologic experience. This resulted in my being appointed to study the health impact of volcanic ash with $2 million funding and help from the Centers for Disease Control and from researchers in Washington state, which was the most affected by the ash.
Forging fulfilling career
My career flourished in Oregon, and I became a well-funded researcher, focusing on lung function and chronic obstructive lung disease (COPD). I successfully submitted my research for an MD from St Andrews. I was fortunate enough to join many committees of the American Thoracic Society (ATS), several National Institutes of Health (NIH) Advisory Boards and Committees and the New England Journal of Medicine Editorial Board, culminating in the presidency of the American Thoracic Society in 1990.
When I was appointed to the ATS Presidency, I gave a lot of thought to what might be my focus. It was during a long day spent alone in a small airport in India after giving talks to the Indian Chest Society that a Chinese proverb came to mind: ‘Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime’. That thought led me to a decision that the best way the ATS could help resource-poor countries would be to teach young doctors how to undertake high-quality research so that they could measure the burden of disease in their countries and understand the most effective ways to manage that burden.
Establishing MECOR
This, in turn, led to the creation of a research training programme called Methods in Epidemiology, Clinical and Operational Research (MECOR), which has grown and grown since its inception, and is now operational in Latin America, Turkey, India, China, Indonesia, Vietnam and Africa with almost 3000 graduates. Most are adult and paediatric physicians in Pulmonary Medicine and Critical Care. These programmes usually consist of five or six intensive days during which students are taught research methods (including statistics) and develop their own research project based on local or national needs. Students then progress through three or four levels with many becoming teaching assistants and course leaders. All are encouraged to publish their research and many frequently do. Many go on to become leaders in their academic institutions, and lead at a local and national level.
Sonia, centre, with MECOR students
Sandblasting and Silicosis
It has been heartening to see the real-life impact MECOR graduates are having as a result of participating in the programme. One particular example is of a group of Turkish students who investigated why some of their young, male patients were presenting with shortness of breath. When digging deeper into possible causes, they found that all worked in the textile industry and had developed Silicosis from sand-blasting jeans (a technique adopted in the 1980s to give denim a ’worn’ appearance).
Those Turkish students succeeded in having sandblasting banned in Turkey, and they are on the road to getting it banned worldwide. In doing so, they are saving lives.
Training female leaders
Given the success of the MECOR programme, I turned my mind to what might be next. I decided to establish the ATS Women’s Leadership Training Programme for Africa. There is a serious shortage of female leaders – in healthcare in particular – in many countries and continents. Africa is just one example.
Leadership skills are now a regular feature of training programmes in academic institutions but that is not the case in resource-poor countries. The pilot of the Women in Leadership programme ran in Kenya in 2024. It’s a small start but I have every confidence that it will be a success. There is so much opportunity for it to grow and to deliver key leadership skills to women across Africa.
L: Sonia in Malawi. R: Promoting the Women’s Leadership Training Program
Hiking on Mt Hood
On top of my work in medicine, I have always loved hiking and am proud to have published a series of books detailing the extensive networks of trails on and around Mt Hood, close to where I live in Portland. My press is called LOLITS (Little Old Ladies in Tennis Shoes). My pocket guides contain everything from maps to recommendations for accommodation and break trails down into segments.
Sonia has published a number of books about hiking on Mt Hood
A continued connection
Sometimes life brings you full circle, and I have remained engaged with the University by helping to support the work of Professor Bernadette O’Hare, who is a Reader in Global Health and deputy head of the Division of Infection and Global Health in the School of Medicine. I have donated towards the GRADE project, led by Professor O’Hare – you can read more about this project here. I am proud to be able to give back to St Andrews in this way.
I am also proud to say that my scarlet gown is now being worn in St Andrews by one of my granddaughters who is in her final year of study in the School of Business. She is enjoying the experience every bit as much as I did!