Senior Alexis Siegler came to Carolina from Decatur, Georgia, choosing Chapel Hill for its breadth of research and interdisciplinary studies. In May, she will graduate with majors in Neuroscience and Political Science, and a minor in Chemistry, along with an understanding that health care is about much more than medical diagnosis and treatment. In the village of Bugoye, part of a lush mountainous region of Uganda, Siegler discovered a complex tapestry of human resilience and systemic challenges, where every statistic represents a human life. Her global health journey began in 2023.
Diagnosing Ehrlichiosis, a Tick-Borne Disease
During sophomore year, Siegler applied for an internship through the Carolina Population Center to do research on tick-borne disease in North Carolina. Mentored by Dr. Ross Boyce, she analyzed molecular testing for Ehrlichiosis and highlighted deficiencies in serological testing from a database of UNC Health patients. Results were published in the CDC Journal of Emerging Infectious Diseases.
“Testing for ehrlichiosis requires two different assays to confirm a diagnosis, at least two weeks apart, and a lot of patients don’t return for that second assay, which is problematic in terms of surveillance. Our investigation revealed substantial underuse of molecular testing in disease-endemic areas and a need to educate providers at all levels of training, and across specialties, on diagnosis and management.”
Siegler’s skills in research and analysis grew. She attended Tick University through the Southeastern Center of Excellence for Vector-Borne Diseases, performed ‘tick drags,’ and shadowed Dr. Boyce in the infectious disease clinic where she saw a patient recovering from malaria after international travel. When she learned about his malaria studies with Uganda’s Mbarara University of Science and Technology, Siegler wanted to become involved.
Severe Malaria in Pediatrics Patients
During her junior year (Summer 2024), Siegler helped Dr. Boyce design a modification to an ongoing study on severe malaria in pediatric patients. This study collects data of children hospitalized for severe malaria and follows up with caregivers 14 days after discharge, to assess treatment adherence to World Health Organization guidelines. Concerningly, about a quarter reported persistent symptoms after discharge.
To investigate this in Uganda, Siegler applied for an Honors Carolina Burch Fellowship. After a competitive review process, she was tentatively awarded the fellowship due to a Level 3 U.S. travel advisory which required a more extensive independent travel approval subject to review by additional committees and UNC’s Vice Chancellor. In the end, Siegler became the first Burch Fellow to travel to sub-Saharan Africa in nearly 10 years.
Two Months in Uganda
Her first week in Uganda aligned with meetings Dr. Boyce had scheduled with local leaders, university faculty and partners. This included meetings to discuss a new five-year “After the Flood” study, investigating the efficacy of post-flooding interventions on malaria rates. He also shared results from insecticide-treated bednets research.
Siegler lived at the Bugoye Heath Centre in visitor housing maintained by the MUST-UNC collaboration. Her work started with IRB and protocol modifications while gathering necessary supplies. She coordinated malaria microscopy with St. Paul’s Hospital, where the study took place, and continued 14-day post-discharge follow-up.
“Depending on symptom persistence, we scheduled home visits and extended follow-ups on a biweekly basis until the 56-day mark post discharge. We gathered feedback to help us to decide whether to schedule a home visit.”
Observing Barriers to Health
To investigate symptom persistence, Siegler and the study team visited homes in villages across the Kasese District, checking vital signs, measuring hemoglobin levels and testing for malaria. One patient encounter went beyond clinical data collection, revealing the intricate barriers that separate life and death in resource-limited settings.
High in the mountains of Katooke, a village neighboring Bugoye, a young boy with sickle cell anemia showed signs of bacterial infection and sepsis, with swollen lymph nodes, a fast heart rate and fever. He was also extremely malnourished, like many of the patients visited. Concerned for the child’s wellbeing, the team suggested treatment at the health center the next day. But with five other kids and a small baby, the mother never appeared.
The next day, Siegler and another student returned to check on the young boy, to try to understand what was preventing him from being seen at the health center. It turned out money for transportation was one barrier, which they then provided.
The young child was given ready-to-use therapeutic food, to treat malnutrition. When the team followed up at the 42-day mark post-discharge, his mother reported that he was not experiencing any symptoms. Yet, the child ultimately died—an outcome that underscored the complex healthcare challenges in resource-limited settings.
“We think the child’s baseline was not very healthy; he had sickle cell and malnutrition. Malaria probably debilitated his system even further. It was so devastating to hear.”
Because malaria symptoms are non-specific, causing fever, headache and nausea, and most post-discharge malaria tests were negative, Siegler suspected other causes for the persistent symptoms. She was learning that many patients have comorbidities and co-infections, such as sickle cell disease, that may complicate malaria treatment, even though the sickle cell trait has been thought to offer a degree of protection against malaria. There is still much to learn.
‘After the Flood’ and Lesu Treatment with Insecticide
Siegler also got to participate in surveying village health teams for the “After the Flood” study, walking from village to village, particularly those around large rivers, to identify those most affected by flooding. This gave Siegler the chance to explore villages hours from Kasese, where she learned about the destructive effects of flooding.
She also learned about the effect of insecticide-treated Lesu–fabric wraps commonly used by mothers to carry their babies–on malaria rates. While she was there, one of the last study cohorts of mother-baby pairs participating in Dr. Boyce’s study attended clinics in Bugoye and another nearby village, where dried blood spots were collected, vital signs were recorded and Lesus were retreated.
Welcoming Culture
Siegler expressed appreciation for the MUST-UNC team who showed her how to do everything from trapping mosquitoes with carbon dioxide lures to burning mud bricks to make houses. And learning extended outside of work.
“Every member of the MUST-UNC team is kind and passionate about improving their communities. Forming friendships and playing with children in the community were some of the most meaningful ways I spent my time. Bugoye communities were the most welcoming and hospitable that I have ever encountered. We were constantly invited into homes and given freshly grown food like mangoes.”
What’s Next? The Future Looks Bright
As the academic year comes to an end, Siegler is finalizing her honors thesis which represents more than an academic achievement. She’s learned true healthcare transcends clinical protocols, requiring empathy and a commitment to addressing root challenges.
Siegler’s experiences in Uganda also inspired the theme for this year’s American Mock World Health Organization (AMWHO) Conference: Bridging Health and Healthcare Disparities between Low-, Middle-, and High-Income Countries to Achieve Universal Health Coverage.
“Although my focus was malaria, I witnessed the exacerbated consequences from health issues that vibrant, beautiful communities around me struggled with,” said Siegler, theme co-director for AMWHO. “Through this theme guide, I was able to extend my learning about some of these deep-seated issues that predominantly affect resource-limited communities.”
Currently a Fulbright Semi-Finalist, Siegler hopes to spend next year in Uganda building on her work in malaria. She also plans to apply to medical school.