Dr Shirin Kalimuddin’s first plunge into the world of medical research happened during week one of her specialty training in the Department of Infectious Diseases (ID). She remembers being approached by Associate Professor Jenny Low Guek Hong, who was then a Consultant in ID: ‘She came up to me and said, “There’s a conference coming up in the US. Can you submit an abstract?”’ Dr Kalimuddin pauses. ‘The deadline was in three days’ time. Back then I didn’t know Jenny that well, but over the years I’ve come to realise that three days is actually a very long time in her timeframe.’
A/Prof Low, who is seated close by, pipes in chirpily: ‘I can make 24 hours look like 48 hours.’
Dr Kalimuddin continues: ‘Jenny is very efficient and organised. That was the first time I worked with her. I saw her style of working and quite enjoyed it. From her, I’ve learnt that you can actually achieve quite a lot in a short space of time.’
A/Prof Low and Dr Kalimuddin are speaking about the start of their mentormentee relationship. Apart from what they share, the relaxed and assured manner in which their voices weave together speaks volumes about their chemistry. Several times during the interview, one doctor will pitch in with either a humourous quip or a complementary detail after the other doctor has finished speaking. They never cut each other off. Their ease with each other, whether in speech or body language, suggests mutual respect and affection.
From the moment they enter this room in Academia for their joint interview, there are hints of their commonality. They are wearing masks but their eyes have a similar air of steadfastness and curiosity. They are slim and they carry themselves with poise; there is simplicity and elegance in their work attire and make-up.
These aspects combine into a strong first impression of sympathy, of their being on-the-same-page as it were, and even of professional parity. One is a mentor, the other her mentee, yet when their masks are removed for their photos to be taken, they seem even more like old school friends than colleagues, one much more senior than the other.
Both women have a shared passion for research. Since that first co-presented conference paper in 2010, they have gone on to collaborate on many others. In 2020 and 2021, a key area of research has been the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) responsible for the COVID-19 pandemic. Since the outbreak, research at SGH and SingHealth has been progressing at a relentless pace. In an article they co-wrote for a publication about Singapore’s handling of the pandemic, they cite the example of a clinical trial concerning the efficacy of the antiviral Remdesivir that was completed in merely four weeks.
‘That would have been unheard of during “peacetime”,’ says A /Prof Low. They use these terms ‘wartime’ and ‘peacetime’ to denote the times when healthcare is fighting an outbreak and when it isn’t. In ‘peacetime’, as A/Prof Low explains, ID plays a critical supportive role across multiple disciplines at the hospital, ensuring infection control and prevention.
Dr Kalimuddin chimes: ‘A lot of people think that we are always dressed in full PPE fighting diseases like Ebola, but that’s not our day-to-day job.’
Her mentor elaborates: ‘For our transplant patients—whether they are bone marrow or solid organ transplants—there is increased risk from all sorts of infections. So ID is a critical aspect of the overall management of patient care in those c ontexts.’
ID plays a similarly important role for patients with postoperative complications after surgery and patients with complicated infections in the medical disciplines. Another significant aspect of ID’s ‘peacetime’ operations is supporting the work of the Burns Unit, as A/Prof Low explains: ‘SGH Burns Unit is the referral centre for the region. When there are severe burns cases, ID is always called in. In fact, the surgeons don’t even wait for the patients to settle in. The moment the patients land [in Singapore], we are notified.’
Whilst both doctors stress that the bulk of their work is in managing ‘peacetime’ nosocomial infections [infections originating in a hospital], the COVID-19 pandemic has, of course, catapulted the ‘wartime’ role of ID into the limelight.
Before the pandemic, there had been threats from diseases like MERS, Ebola and H1N1. The biggest test, and the most unforgettable, had been SARS. A/Prof Low’s reflection on the impact of SARS on SGH echoes what other staff from her generation have said about that traumatic time:
‘SARS taught us a lot of precious lessons. If you compare it with COVID-19, you’ll see that SARS affected healthcare workers in hospitals a lot more than the community. After SARS, we put different p olicies in place at SGH.’
At the time of this interview in April 2021, no one at SGH had come down with COVID-19 through caring for patients with the infection. It’s a situation that shows the preparedness of SGH for ‘Disease X’, the anticipated global health calamity. After SARS, there were years of planning and dry-run rehearsals: ‘A lot of people don’t realise this. To a certain extent, we were prepared to counter COVID-19 because of all the rounds of practice we have had beforehand. Whilst fighting MERS, H1N1, and the possibility of Ebola, we learnt how to deal with international health crises.
With H1N1, things came under control as it turned out to be not so bad. And ZIKA, too, is a relatively mild disease.’
A/Prof Low points out that one of the silver linings of COVID-19 has been the heightened awareness of infectious diseases. She says indignantly: ‘We are in the 21st century and people are still dying of infectious diseases!’ Dr Kalimuddin is nodding. She c ontinues her mentor’s train of thought: ‘There’s a lot more work that needs to be done in ID, and not just for COVID-19. Last year, we had more deaths from dengue fever in Singapore than we did from COVID-19. These are big issues, not just in Singapore, but worldwide. There are a lot of other viral infections for which vaccines and treatments have not yet been found.’
In 2020, more than 30 deaths in Singapore were caused by dengue fever, a higher rate than that of COVID-19. Apart from local outbreaks, there have been other red-flag situations like the Ebola crisis, which is singled out by A/Prof Low:
‘Ebola made us realise that we needed to do more. Because people were dying. The Ebola mortality in some places was 70 to 80 per cent depending on how much supportive care there was.’
Both doctors believe strongly that better drugs and vaccines can be discovered to prevent people from dying of infectious diseases. This hope and conviction is what drives their efforts in research. They are part of SingHealth Duke-NUS Academic Medical Centre’s Viral Research and Experimental Medicine Centre (ViREMiCS), which has contributed to global understanding of SARS-CoV-2 in a number of significant ways. ‘We were the first in the world to describe the dynamic changes in COVID-19 patients on a day-to-day basis when the patient was sick,’ A/Prof Low says, glancing at Dr Kalimuddin before she continues: ‘Shirin is running another monoclonal antibody trial for a US company. The team also uses research blood samples we’ve collected to look at the gene expressions, to p redict p otential side-effects.’
Another driver of their research is infection prevention for the local community. Flavivral diseases—diseases transmitted by mosquitoes and ticks which include dengue fever, yellow fever and congenital Zika syndrome —is a key area of research. When they speak about the need to pay equal attention to diseases that are headline news in the western media and those that affect the lives of Singaporeans and residents here, there is a steely cautionary note in both their voices.
Dr Kalimuddin shares that it was the breadth of ID that attracted her to pursue it as her specialty. She likes that ID allows her to see the surgical problems that surgeons have to manage as well as patients from all the different disciplines. Meeting an enabling mentor like A/Prof Low also made a difference.
A/Prof Low is enthusiastic when she mentions the people who have helped her grow as a clinician and scientist over the different stages of her life: ‘When I was very young, my clinical mentor was Dr Simon Ong from Medical Oncology. He was a big influence in many ways. After I moved on into subspecialties, other mentors came into my life. When I was an ID trainee, there were two senior doctors who mentored me: Asok and Ban Hock.’
The doctors are Dr Asok Kurup and Professor Tan Ban Hock, a Senior Consultant in ID. Dr Kurup has left SGH for the private sector.
‘Ban Hock, as we all know, is an inspiring physician —very selfless, affable, available. All the A’s!’ says A/Prof Low, bursting into laughter. ‘After I moved into research, in the early days both Subhash and Eng Eong were instrumental in getting me started on the track.’
She is referring to Professor Subhash Vasudevan who is currently at the Duke-NUS Medical School. ‘For me,’ Dr Kalimuddin says, ‘apart from Jenny, Eng Eong has taught me a lot. I’ve learnt so much from both of them. And Jenny has become more than just a m entor. We are friends.’
Professor Ooi Eng Eong is Deputy Director of the Emerging Infectious Diseases Programme at the Duke-NUS Medical School and a professor at the SingHealth Duke-NUS Global Health Institute. He is also mentioned by A/Prof Low as an esteemed colleague and co-author of papers on dengue fever. Role-modelling has come up in almost all the interviews for this publication. No other doctors have talked, though, about accompanying their mentor to collect blood samples from colleagues over a weekend. Dr Kalimuddin and A/Prof Low were researching antibodies and T-Cells in people who have been vaccinated against COVID-19. They had asked their colleagues for their blood samples because healthcare professionals were amongst the first to be vaccinated.
‘Lots of people volunteered,’ A/Prof Low says. ‘The gate to my house was kept open all Sunday for people to d rop off their samples. Cars kept c oming in and out.’
It is a life-affirming anecdote on many counts. The impact that is made by one human being on another can go on to benefit the lives of so many others—that is one way to see the effect that Dr Kalimuddin’s mentor has had on her life and the lives of patients. And the same can be said for A/Prof Low and her mentors’ influence on her. Both of them are perfect exemplars of A /Prof Low’s two essential criteria for a fulfilling career in research: ‘One is you must have the passion, the second is you must have a very good mentor. You can have passion, but if you don’t have a good mentor, your research will go nowhere. And if you have a good mentor, but no passion, then forget it, you will never like what you do, you will end up hating what you do, so why do it?’
Associate Professor Jenny Low holds a MBBS from the National University of Singapore, a MRCP from the Royal College of Physicians UK and a Master in Public Health from Johns Hopkins University, US. She is a board certified Infectious Diseases physician and is currently a senior consultant at the Department of Infectious Diseases, SGH and a faculty member at the Programme in Emerging Infectious Diseases, Duke-NUS Medical School. She is a clinician scientist with close to 20 years of experience in clinical research. Her research focus is to translate bench based findings into clinical applications. Her notable research include the first anti-dengue drug trial conducted in Singapore in 2012, and several first-in–human monoclonal antibody trials against viruses such as Zika (2016), Yellow fever (2018) and SARS CoV-2 (2020). She co-founded the Viral Research and Experimental Medicine Centre @SingHealth-Duke NUS (ViREMiCS) with Prof Ooi Eng Eong in 2016 with the goal to develop and implement molecular endpoints for the acceleration of clinical trial evaluations of new therapeutics and vaccines against acute viral diseases.
Shirin Kalimuddin holds an MBBS with distinction from King’s College London, and a Master of Public Health from Johns Hopkins University. She is clinically trained as an infectious disease specialist and is a Consultant with the Department of Infectious Diseases at SGH. She is also a faculty member with the Programme in Emerging Diseases at the Duke-NUS Medical School. Her research spans basic, translational and clinical sciences, with a focus on developing better vaccines and therapeutics for emerging infections. Shirin serves on the Executive Committee of the Singapore Infectious Diseases Clinical Research Network (SCRN), and in 2019 she was awarded the National Medical Research Council Transition Award to study the immunostimulatory effects of aminoglycosides in flaviviral infections.