Ramya Ramaswami, M.B.B.S., M.P.H.
By Sonia A. Garcia, Ph.D., Scientific Program Manager, Office of Cancer Research Capacity Building
Ramya Ramaswami, M.B.B.S., M.P.H., is a medical oncologist in the HIV and AIDS Malignancy Branch (HAMB). Formerly a Physician-Scientist Early Investigator in the HAMB, Dr. Ramaswami was recently appointed as a Lasker Scholar Tenure-Track Investigator. She is also an NIH Distinguished Investigator. She leads the natural history and treatment study of patients with HIV-associated cancers, specifically Kaposi sarcoma herpesvirus-associated disorders and malignancies at the NCI. Dr. Ramaswami received her medical degree from Imperial College London and a Master's in Public Health from Columbia University Mailman School of Public Health. She completed her medical and oncology training within the National Health Services of the United Kingdom. Before arriving at the NIH, she completed her oncology fellowship at the National Centre for HIV Malignancy at Chelsea and Westminster Hospital in London, Europe's largest research and treatment institute for HIV-associated cancers.
I had the privilege of speaking with Dr. Ramaswami about her work here at the Center for Cancer Research, her journey to becoming a physician, and her experience coming to the US while her parents remained in her home country, India. As our conversation progressed, I very much related to Dr. Ramaswami's story. I come from a family of immigrants and was reminded of the impact that leaving your family to pursue your career aspirations can have and the guilt that comes with it. I left the conversation inspired and I applaud Dr. Ramaswami for her resilience and grit in pursuing her dreams and making her parents proud.
Congratulations on becoming a Lasker Clinical Research Scholar! Can you tell me how this came about and what this means to you?
Thank you. From 2019 I was part of the Physician-Scientist Early Investigator program at the NCI and received guidance from my mentorship committee on my clinical and scientific endeavors. During my third year of the program, I developed projects that have the potential to impact our participant population and wanted to explore a path to an independent position to advance these ideas. The Lasker Clinical Research Scholars program was a great fit and there have been several investigators who have led the way in developing clinical-translational work that benefits patients. It means a lot to achieve this role and I am grateful for the support of my phenomenal colleagues in the HAMB Branch and my mentorship committee.
Can you talk a little bit more about your research and how you decided to focus on this specific field; was it different than your interests in your early career?
I was born in Singapore and moved to the United Kingdom to start my medical education and training. I was always very interested in helping people who had different organ system issues. I had narrowed it down to either infectious disease, geriatrics or oncology. I always ended up finding myself in the room when people were having difficult conversations with patients, such as breaking bad news, delivering a cancer diagnosis or talking about end of life. Being involved in the care of a patient with cancer, I realized that you become the primary physician to the patient and their family. You become everything because you are their doctor during these challenging times. You build a relationship with the patient, and I loved being a part of the continuity of cancer care. During my oncology fellowship, there were so many advances to keep up with – with the application of immunotherapy to mainstream cancer care and seeing patients benefit from these advances. As an oncology fellow, I worked in the national HIV malignancy center in London and was drawn to the patient population. Many of these patients were immigrants and had been disenfranchised by the medical system, even though healthcare in the UK is free. People with HIV and cancer also need a lot of multidisciplinary care to improve their cancer outcomes – they need doctors, nurses and pharmacists from infectious disease and cancer to guide their health management.
I jumped at the opportunity to care for this population in the US, where with a larger population, health disparities are perhaps even more evident. This opportunity to answer questions for this population of people with HIV is important as it’s an underrepresented group in cancer clinical trials.
How long ago, and why, did you decide to come to the US?
I got married about halfway through my fellowship training in the UK – my husband was based here in the US. In 2016, when I graduated from my fellowship, I was looking for opportunities to bridge our transatlantic union. I was in Boston for a year where I was fortunate to work as an editorial fellow at the New England Journal of Medicine. In 2017 I joined the HAMB which aligned with my scientific and clinical goals to care for people with HIV and cancer. I wanted to help and serve here in the US, bringing my clinical experiences and scientific insights to the HAMB. I was also excited to be a part of the NIH given the large number of scientists and clinicians who also identify with the immigrant experience.
Did you experience any culture shock?
The work culture in the US is very different from the UK, but I've found that in the US, people are highly collaborative, encourage creativity and ideation, and enjoy talking through complex problems, especially in the biomedical field. I always find that my mannerisms and sayings are British-inclined as I was brought up in Asia in countries that were previously British colonies and trained in England. Finding a good cup of tea is hard at times!
In terms of culture shock, I think the relationship between a patient and a physician is universal no matter where you go. You have a patient who needs help and a physician who can help them. But of course, medical systems are very different. Having trained in the National Health Service in the UK, where everything is free, it was very different to be in the US where there are so many different systems of paying for healthcare – understanding these differences are important as they give me insights into the challenges our patients face as they navigate their illness.
How do you balance being an immigrant and pursuing your career in a different country than where your family is?
When I left home at the age of 18 to start medical school, they had just released calling cards; you would scratch the back of the card to be able to call home. Since then, I think technology has advanced a lot and that really helped us all get through COVID-19, too. I didn't see my parents for two years. A phone call and a message are so much easier nowadays. It's all you can do is keep the lines of communication open, right? Whether that's email or Facetimeing and WhatsApp; I'm still in touch with my friends in the UK.
I was raised here in Maryland, and I took a postbaccalaureate position in Houston, TX. I felt guilty for leaving my parents and I think many immigrants, or children of immigrants, can relate to that feeling.
Yes, there is a lot of guilt because you always think, well, is this the place I'm supposed to be? This year my father had an accident and I had to go home. It took me 34 hours. In an emergency setting, everything stops. I kept thinking, I must get home. There's a tremendous amount of guilt because you’re not in the country where your family is. And most people just live close to their families, right? But my parents worked so hard for me to succeed professionally.
Anything I do, all the work that I do, is honoring my family. I am aware every day that the support they give me is completely necessary to get anything done. When my father passed away from the accident, I told my mother, “Maybe I should move back to India” and she said, "That's ridiculous, you have work to do in the US.” I think with resilience, it’s important to consider how to address it in several aspects of life and work. As someone from an immigrant background, resilience frames a lot of how you operate as it takes so much to move countries, start fresh, and learn the cultures and traditions of a place you're in to develop a new sense of belonging.
I am so sorry for your loss. I point out resilience because it’s a trait that we develop as we navigate these different spaces and systems that our parents might not have. We become resilient by necessity.
I’m more mindful these days with the events happening in my life, both celebratory and those that are heartbreaking. I am trying to pause and take more time for myself to reflect more. Being in the States is very different from Europe. Work-life balance is very different, and I do try to remind our team to take a break and reflect as we all go through a lot caring for our patient population who can be so unwell and need a lot of patience, care and compassion.
What would you tell your younger self?
I think I would say that it’s all going to be OK, hang in there and be kind to yourself. Medical training is arduous and there is so much imposter syndrome in this field when you are a woman, a person of color, an immigrant. I would say just keep going.
Aligned is a blog written by the Center for Cancer Research's (CCR) Office of Cancer Research Capacity Building discussing workplace engagement and highlighting various ways we can all be more involved in creating a more successful scientific workforce.