Neudy Rojop, 29, stands on a bumpy, cobbled lane in Guatemala in the small rural village of San Rafael Pacayá. It leads to the home where she grew up and where she still lives today.
"Just in this lane," she recalls through an interpreter, "my mom used to walk me and my brother and my sister to school every morning."
Many of her relatives live nearby — uncles, aunts and a younger cousin named Carlos, or Carlitos if you're family. When Rojop was about 10, she says she remembers an urgent knock at their door one night. It was about Carlos.
"My aunt came to my house asking for medicine because he was so sick," Rojop recalls. They grabbed whatever they had — medicinal syrups, herbal teas — and raced out of the house. "I remember the moment when I saw him," she says. "He was lying on the bed. He was with this fever and his skin was red."
Carlos was struggling to breathe and his family couldn't afford the transportation to get him to a private doctor. Without any local clinics, Rojop's family couldn't even figure out what was making him sick. "We were just waiting for him to recover," she says.
After several days, he got better. Looking back, Rojop figures he had the flu or some kind of pneumonia. But it wasn't just Carlos. She says that growing up, she noticed how frequently many of those around her were getting sick, especially her little siblings and cousins. She says that as a teenager, she started to realize more-urban communities in Guatemala had better access to health care.
"I didn't think it was fair," Rojop says, "because I didn't know how to help my family members who were sick to get better."
It all crystallized within Rojop into a singular decision. "I thought, 'I need to become a nurse so I could change my community for good.' "
In San Rafael Pacayá, Rojop's options were limited. There was nowhere nearby to study or practice nursing at a more advanced level. Her schooling took her increasingly far away, but she continued to live at home. "I didn't imagine myself moving out from this community," she explains.
Ambitions for a clinic and more
It turns out, about half an hour's drive away, the lack of medical care in rural parts of Guatemala was bothering someone else as well. During the years when Rojop was studying nursing, Dr. Edwin Asturias was returning to his hometown for a visit to think about how to bring more care to the community. He recalls a day he was standing on the roof of a school in Chiquirines, in the far western part of the country just a few miles from the Pacific Ocean.
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Asturias, an infectious disease pediatrician with the University of Colorado, had grown up pretty close to that spot and, like Rojop, he witnessed how poverty, malnutrition and a lack of medical care created repeated cycles of disease battering his community.
From the rooftop, he gazed at the dirt field next door, where only a single almond tree stood. And he thought, "This could be way more than a parking lot. This is going to be where we're going to build the clinic that could provide service to the population," he recalls.
Asturias' vision swelled beyond a clinic. He wanted to train people and build space to do research "to better monitor these illnesses," he says, "and try to provide early interventions rather than late interventions, or try out new therapies or new ways to prevent some of these illnesses."
The people here "may have the common viruses," he explains. "Those that are knowns. But also there may be an emerging virus that we don't know about."
In other words, he wanted to do surveillance to keep emerging infections from ever posing a threat in the first place.
The idea was pretty audacious. High-level research usually happens in the big cities. But Asturias was undeterred. He remembers looking out at that lot and seeing that almond tree: "And I said, 'That tree needs to remain there, because it's going to be the shade that will provide that comfort for the people that are working there.' "
Over the next few years, Asturias gained support from the University of Colorado, Children's Hospital Colorado and a local banana and palm oil company. He and a small team brought his vision to life.
The almond tree still stands. Today, it's surrounded by five large, low buildings. They comprise La Fundación para la Salud Integral de los Guatemaltecos, or FunSalud for short. It's part health clinic, part grade-A laboratory. The clinic is usually busy with a staff of six seeing about 300 patients per month.
Think globally, act locally
Inside, Dr. Dan Olson, a pediatric infectious disease doctor at the University of Colorado and a research director here, is like a kid showing off his toys. He points out DNA sequencers, ultra-cold freezers and the air conditioning necessary to keep all the equipment from overheating. And he explains it's all powered with consistent electricity from solar power — blackouts and brownouts can be harmful to laboratory equipment.
"Our site is, I think, in a good spot to pick up some emerging pathogens from this region before we're in a pandemic," says Olson. Think back to COVID, he says. "Hospitals were already filling up with this unknown pneumonia by the time we even had a clue of what was going on. But it already spread beyond China's borders before we even had a name for it."
Instead, FunSalud is doing what's called active surveillance — with studies aimed at going out into the community to look for emerging diseases with pandemic potential. "[It] gives you a better chance to develop interventions, whether it's diagnostic tests, whether it's vaccines, or even some clear public health measures we think will limit the risk," Olson says.
To do this work, you need a sophisticated lab. Olson says FunSalud is on par with something you'd find in the United States.
But in the early days, a question loomed. Who would want to work here doing research in the tropical heat surrounded by mosquitoes? Who would trade in Guatemala City or the Centers for Disease Control and Prevention in Atlanta?
"We struggled with this," says Olson. "Initially, we had thought about bringing in a grad student from the U.S. But then they go get their job somewhere else and they're never back again."
So Olson and his team started looking locally — around the time that Neudy Rojop showed up. And she is emblematic of the way the research center operates.
"We hired her right out of nursing school," explains Olson. "She had zero clinical experience and she had zero research experience." She started as a nurse with their first research project on dengue. Olson says something became clear immediately. "She was a superstar," he recalls. "You'd give her an idea and then she would run with it a mile." So FunSalud mentored her to become a study coordinator.
Every morning, Rojop walks down that lane in San Rafael Pacayá before boarding a yellow school bus that picks up much of FunSalud's workforce. When the bus arrives, a couple of dozen people file out, including researchers, technicians, the accountant and the cook.
Rojop has worked at FunSalud for almost a decade, and she's moved up the ranks. She's come to really love research, and now she's a research coordinator.
Rojop starts her days inside the building called Research One, at a morning meeting with the other team leads, making decisions, solving problems and setting priorities.
The place is a flurry of activity. In the main area of the building, the several dozen junior researchers who power this place divide up by research project. One team is conducting disease surveillance among farmworkers. Another huddles to assess whether mosquitoes can operate like a swarm of flying phlebotomists to collect the blood of people and animals across dozens of nearby households — blood that can be scanned for pathogens.
One by one, the research teams finish their discussions and begin their work. Rojop steps outside. "Now we're heading to Chiquirines," she says as she gets behind the wheel of a tuk-tuk. Rojop leads one of the research projects monitoring people in the community for disease — both known illnesses and possibly ones not seen before. She fires up the three-wheeled vehicle and drives off to the home of one of the families involved in the study.
Dr. Mirella Barrientos helped lead the search that brought many of Rojop's colleagues to FunSalud. She's the other research director here, and she says there was tons of talent in FunSalud's backyard. "We want people of here," she explains, "that can work for their community, their families, their children."
When Barrientos hires researchers and nurses, she looks for one thing above all: "This curiosity for research, curiosity for growing in their learning." So they can excel at one job and possibly grow into others.
For instance, several years ago, a lab tech broke her arm and the lab needed someone who could draw blood samples from people and animals. The lab director remembered someone named José Anaya, who transported equipment. They brought him into the lab, taught him the ropes and he loved it.
Anaya says that temporary gig at FunSalud changed his life. There just aren't a lot of job options around here. Now he's had a chance to work as a lab tech, and he's hoping to be invited back next month to assist with a new research study.
Barrientos and Asturias say they've seen people grow into new and bigger roles over and over again.
"We're trying to show them that you don't need to go to the United States to do your graduate degree," Asturias says. "That you can do it here, practice your craft here, and do better for your own people."
At the end of the day, the yellow bus returns to FunSalud to do its morning route in reverse. Rojop climbs aboard to ride the half-hour back home. By day, she sees a lot of disease, and that memory of little Carlos falling ill all those years ago often resurfaces.
"The difference is before I was so young that I couldn't do something for him," she says. "But now I can help because I know how."
