Spotlight Interview with Dr. Christina P.C. Borba

“My joy for global health is asking and working on, ‘How do I build the next generation of scientists in this country?’” – Dr. Borba 

Location: Boston, USA

Bio: Dr. Christina P.C. Borba, PhD, MPH is the Vice Chair of Research for the Department of Psychiatry at Boston Medical Center (BMC) and an Associate Professor of Psychiatry at Boston University School of Medicine (BUSM). Until 2016, she was the Director of Research at the Chester M. Pierce, MD Division of Global Psychiatry at Massachusetts General Hospital (MGH). Dr. Borba has extensive experience in mixed methods research, teaching, training, and development and management of randomized clinical trials. Dr. Borba’s current research focuses on psychotic disorders and cultural psychiatry in low-resource settings in the U.S. and abroad, women’s mental health, and gender differences in care. Dr. Borba’s research has examined socio-cultural aspects of schizophrenia in Ethiopia with a goal of understanding why the disease prevalence ratio has been found to be 5:1 male to female (a statistic unlike any other in the world). She is also involved in ongoing efforts in Liberia to increase local research capacity with the University of Liberia, and to identify and conduct priority mental health-related research with in-country academic leaders. In her role as Vice Chair of Research, Dr. Borba works to expand departmental research capacity through research education initiatives for residents and medical students, mentorship of junior faculty, new faculty recruitment, and the expansion of research infrastructure capacity within the department. She supervises and provides research-related trainings for all research teams within the Department of Psychiatry.

Let’s start at the beginning, can you take us through your career journey to where you are now?

This a great question, especially for young people who are trying to figure out what they want to do next. At this stage in my career, I think it is easy for it to appear as if I’ve had it all figured out and that I must have gone on a linear path when that simply was not the case. I went to Northeastern University for undergraduate studies, and there they instill an experiential learning program, also known as a co-op, where you had to work full time for six months and complete at least three co-ops during your time at the University. At the time, I was convinced I was going to be a clinical psychologist. My first two co-ops were very clinical experiences. It was my third co-op where my advisor had suggested I pursue research to be a better-rounded applicant. To that I responded, “I have absolutely zero interest in research.” It’s quite funny given my title today. After much convincing, I decided that it was the right time to experiment, and I started a research assistant position at the Schizophrenia Clinical and Research Program at MGH with Dr. David Henderson. During my time there, ironically, I fell in love with research. At this point, I was still convinced that I would be a clinical psychologist and was given “advice” from my mentor that I should explore public health. But it was some of the best advice I had gotten because it really allowed me to reflect on my interests. My interests really were more interested in what was outside a patient’s control such as homelessness, poverty, violence, addiction, and food insecurity. I ended up taking his advice and really took a pause to figure out what to do next. I decided to pursue my Master of Public Health (MPH) as a way to figure out if it was something I would enjoy. Probably within the first week of classes, I had the “AHA” moment. I thought, “I get it now; I am supposed to be in public health.” I still get to make an impact on patients, but in another realm. From there, I ended up pursuing my PhD at Emory University under the guidance of another mentor, Dr. Claire Sterk, an anthropologist, and later President of Emory University. I already had significant clinical, quantitative, and statistical experience, but I figured I needed to gain experience in qualitative and mixed-methods research.

So where did your interest in global health arise?

At this point, I had no experience in global health. All my work had been done domestically and all within safety-net hospitals. I grew up in a Portuguese household with Portuguese immigrant parents, but I did not identify as a global health researcher. That did not happen until I was given the opportunity to be the Director of Research for Chester M. Pierce, MD Division of Global Psychiatry at MGH. Ironically, I had a fear of flying, but kind of had to get over that real quick! For my first international trip, I traveled to Uganda. There, I had another “AHA” moment. I realized this kind of research and work really combines my love of public health, mental health, and working with vulnerable patient populations. A lot of people may think that this position was something that I was working towards, but it wasn’t so strategic. An opportunity kind of fell in my lap. Now I am building research capacity in a department that serves vulnerable patient populations. My ultimate goal is to look back and see a department with competent and productive researchers that study health disparities within mental health.

Can you elaborate on why global health matters to you?

The trip to Uganda solidified for me all my interests and things I wanted to contribute to. Global mental health is population-based health, and you constantly have to think about how you’re going to reach a critical mass of people. Yes there is a clinical component, but in terms of developing that capacity you really have to think about it with a public health lens. What I love about global work is the capacity building aspect. My joy for global health is asking and working on “How do I build the next generation of scientists in this country?” I can offer my knowledge, expertise, and training that these students have not been afforded. I look at it as a relationship of sharing this knowledge base. It really did take several trips for me to name it. Then I finally was able to put my finger on it: that’s my love for teaching, that’s my love for mentoring, and that’s my love for wanting to make a bigger impact – research capacity building.

Can you share with us some capacity building initiatives you are a part of?

I went to Ethiopia for about a month and Ethiopian colleagues asked me to teach research methods and statistics to their PhD students. The course ended up being day-long and week-long classes. You could see the knowledge and interest growing over the week.

From that spurred my relationship with our partners at the University of KwaZulu-Natal (UKZN) in Durban, South Africa. Dr. Bonga Chiliza would coordinate a week dedicated to learning about research and I would travel to teach students. I now go every year in February, and I get people from all different departments, not just from psychiatry, but students in cardiology, surgery, and dermatology. It is quite amazing to see the students ready and eager to learn about research methods and statistics. What we are noticing now are the trainees from the beginning are starting to receive their own grants. It has been so rewarding to see them become trainers and mentors to the new group of scientists. I also do a lot of individual meetings with PhD students, and they always come in with many questions and are inspired to learn. Unfortunately, due to the pandemic we’ve been hosting the research week virtually, but that even allowed us to expand our services. We were able to invite our psychiatry residents in Liberia to attend virtually. This circles back to the mission of the Africa Global Mental Health Institute (AGMHI) and why we created it. It’s about connecting the dots. We have to start thinking about opening this up to other people, even if not in-person some sort of hybrid opportunity. Imagine the impact we could make?

Can you speak on building lasting partnerships, relationships, and mentorships?

I think mentorship is super important in all aspects of someone’s life. I still have a lot of senior mentors that I still go to. One mentor cannot fulfill everything, like any relationship, we go to different people in our lives depending on what is going on. I would caution against having the expectation that you should have only one mentor. Having both good and bad experiences are super important, so you’ll really know when you have a mentor that you connect with.

My two most influential mentors in my life are Dr. Henderson and Dr. Sterk. They couldn’t be any more different from each other, but that is exactly what I need. I need their different perspectives and different styles of mentoring. Because of them I was able to create my own path.

I’ve now been working with Dr. Henderson for over 23 years. Our skillsets are very different, but complimentary. He has given me this space to pursue my own interests. It really is a testament to being a good mentor. It’s about not putting their own career aspirations onto you while being able to balance pushing you to do better. He has always had faith in me; He would always say: “She’ll rise to the situation.” Even though he is technically my supervisor, I feel lucky that I can ask him to put his “boss hat” down and put on his “mentor hat.” But that is what makes him a good mentor.

Can you talk about serving as Associate Director of the NIMH T32 Fellowship?

The T32 has been positively evolving over the years. You can ask most senior level researchers and one common theme would be we all would like more time to mentor. Historically, we have tried to recruit women and one of my goals is to make sure women stay in academia. I am afraid that we are going to lose our women scientists, so I view this fellowship as an opportunity to make sure we retain women in the field. If it takes me being brutally honest about the academic obstacle course we must all navigate, then I’m willing to do that. I am here to show an example of a woman in an academic career. I am here to stay. You have to ask yourself, “What example are you setting for the ones who look up to you?”  

Can you talk about being the Director of the GLCMHD?

In every country, every institution has so many strengths already embedded in their infrastructure, in their faculty and in their trainees that make them up. It goes back to “connecting the dots” together. For example, our Ethiopian partners are experts in psychiatric epidemiology. I see this as a possible opportunity for cross-training across the African continent. I want to continue on building those connections. It doesn’t always have to be us going into a country. I have seen remarkable capacity both clinical and research capacity across the globe. The spirit of the work we are doing is to start those collaborations within the continent. We are in the process of applying for funding that allows for training capacity, both clinical and research, and uniting our colleagues to work together. There are strengths in the countries we work in, and we need to capitalize on them. It is amazing to see this surge of interest in people pursuing research careers. We currently have the T32 Global Psychiatry Fellowship, which is a training grant for U.S.-based researchers. One of my goals is to mimic that sort of fellowship and training for our researchers in low- and middle-income countries to create that same protected time. Clinical demands are intense and it’s hard to have funding to protect our students’ time to dive into research. We have the tools; we can mirror the T32. We just have to start utilizing them.

Closing thoughts

It sounds cliché but take it one day at a time. Try to enjoy your work. Build a skillset. Let the path figure itself out. Keep an open mind and let it play out. We don’t have to have it all figured out today. And that speaks to all size and scope of projects. There is this urgency to solve the world’s problems with one enormous project. I am very much of the mindset of slow and steady progress, and I value quality over quantity.

 By Joanne Won, March 2022