March 2014 Archives

Nate Herr (PL2) on Getting an R01 Study Launched

Posted on behalf of Nate Herr (PL2)

After the safari, I returned to my routine of rounding in the PICU and stabilization room 2-days a week.  The remaining days of the week were dedicated to the various and many research study tasks surrounding getting a new R01 study launched.  This study will follow a spectrum of children admitted with severe malaria-- taking detail to discover more about the causes and outcomes of the different types; Coma, Seizures, Anemia, Acidosis, and Prostration.

Chandy John, Director of the Division of Global Pediatrics at UMN, had arrived in Uganda while I was out on safari.  In the next 3 weeks that he was here he facilitated meeting after meeting on his multiple clinical studies here-- including the NDI study I've been working on and described briefly above.

To answer a question, you need data.  And to get data you need forms.  The forms for our study collect somewhere around 7,000 variables per patient.  With our goal to take in all comers with severe malaria, we are expecting a lot of variables and a short and fast enrollment period-- both of which called for efficiency in the data collection and verification process.

CRF4.jpg

Karen Hamre, MPH, a PhD candidate at the UMN and current Fogarty Fellow, arrived 2 weeks ago and brought her skilled eye for detail and perspective of data analysis to the group.  It took almost a weeks worth of revisions and multiple rounds of feedback from everyone.  We spoke with everyone from the bedside nurses to the principle investigators to create a set of forms that we believe will efficiently and accurately collect the information we'll need. While it brought on headaches, it was great to have the many perspectives involved early on before the actual roll our of the study.

At the end of Chandy's time here, we weren't yet ready to enroll any patients, but we had made much progress in ensuring that the process would be smoother when it happens.  That last weekend he was here, the Global Health Uganda staff from across the country met for their annual retreat, and ventured out to an island in Lake Victoria.

boat.JPG

For most it was their first time at the island, and for many it was their first time on a boat.  With the entire GHU staff at the island you soon saw how they were a big family, enjoying the company and friendships build over time as the NGO approaches 15 years.  It's been a great privilege to work with them as it's apparent to all that they strive for excellence in whatever their task or role.

cuttingcake.JPG

The retreat did it's job in bringing rest and relaxation, something we needed with the multiple studies set to launch this spring.

Nate Herr's (PL2) Safari Story in Pictures

Posted on behalf of Nate Herr (PL2)

Hello again from Uganda!  I realize now that it's been a month since last checking in with our blog-- sorry about that!  I've been quite busy with a few things.  Chandy John has been on site and we've had productive meetings, and have been working on editing of forms to make our data collection more efficient.  Look for an upcoming post with more details.  

Since arriving back in mid-February for my 2 month rotation there was time to fit in a visually breathtaking safari.  

safari.JPG

I took some of my PTO in early March when Abby came to visit for a week. While we did spend a couple days around Kampala and at the Mulago Hospital, we first went up north on a 3-day safari.  Our main stops along the way were the Ziwa Rhino Sanctuary, where they're reintroducing them back into their natural habitat after being poached to elimination years ago, the big Murchison Falls Game Park, and the Budongo Forest for chimp tracking.  

Pictures say it all, so here they are! 

sunrise.JPG
Sunrise

rhino1.JPG
Rhinos resting in Ziwa Rhino Sanctuary

rhino2.JPG

murchison.JPG
A view of the Murchison Falls Game Park

antelope.JPG
Antelope at the Murchison Falls Game Park
elephant.JPG
An elephant at the Murchison Falls Game Park

giraffes.JPG
Giraffes at the Murchison Falls Game Park

hippo.JPG
A hippo at the Murchison Falls Game Park

warthogs.JPG
Warthogs at the Murchison Falls Game Park

cranes.JPG
Cranes at the Murchison Falls Game Park

croc.JPG
A crocodile at the Murchison Falls Game Park

mahoganytree.JPG
A mahogany tree

chimp1.JPG
A chimpanzee at the Budongo Forest

chimp2.JPG

nateabby.JPG

Hope you enjoyed the photos!
-Nate

Danielle Dhaliwal (PL3) describes her time in Arusha

Posted on behalf of Danielle Dhaliwal (PL3)

Jambo from Arusha!

The house we are staying in in Arusha is up a steep hill away from town but it is on a bustling street - between barking dogs, nightly music, honking horns and pouring rain we are thankful to have ear plugs to allow some quiet sleep .  The house is adorable and we are currently sharing it with a 3rd year medicine resident from Denver, CO.  A medical student from Australia will also be joining us this week. 

 Living Room at Exempla House - Tanzania.jpg
The living room in the Exempla House where we are staying.

In Arusha we began our time at Selian Hospital.  As Danielle and Emily mentioned, it is about an hour and a half walk up a muddy hill but, fortunately, there is a retired Medicine physician from MN, Ron Eggert, who is here for the next year and he and his wife are kind enough to pick us up and drop us off on most days.  
 
Walk to Work - Tanzania.jpg
The walk to work this morning.

Ron's wife Ingrid works at the Plaster House, and we had the privilege to get a tour of the facility the other day - what a beautiful and inspiring place.  The Plaster House is a home in Arusha for children from around Tanzania to recover in after they have had corrective orthopaedic surgery, plastic surgery or neurosurgery for a disability.  The Plaster House is particularly busy this week - a group of surgeons just arrived last evening and will be performing a number of complex surgeries over the next 4 days.  

Plaster House - Tanzania.jpg
The Plaster House

Today was the screening clinic and Dr. Swanson and I helped in seeing some of the pediatric cases to ensure they were safe to proceed with anesthesia.  We saw so many children today who will benefit immensely from their being here, I was so happy to be a part of it.  A majority of the cases were cleft lip/palate and burn contracture revisions.  One of the cleft kids was referred to us for a heart murmur.  Not only did she have a 6/6 holosystolic murmur but she had a webbed neck, short stature, shield chest, and other features possibly suggestive of Turner's syndrome. Another child had fallen several months ago onto her chin.  She had fractured her mandible at bilateral TM joints and without proper physical therapy her TM joints fused and she was unable to open her mouth and her mandible growth had been stunted.  Another child had sustained burns to the back of her legs and sadly developed severe burn contractures and was only able to walk with both of her knees bent.  

One patient had been seen by the plastic surgeons however was referred to us because of severe and poorly controlled atopic dermatitis.  The patient had been seen in clinic before and was diagnosed with urticaria but had not received topical steroids and has since developed superinfection of many lesions and possibly eczema herpeticum.  

 severe and poorly controlled atopic dermatitis - Tanzania.jpg
Poor guy was so itchy and uncomfortable and so inflamed that I could feel almost every lymph node he had.  It was my first time feeling epitrochlear nodes.

We prescribed a number of medications and to ensure that this infant received what we had prescribed I walked with her and her child to the pharmacy down the street.  Between the topical steroids, antihistamines, emollients, and antibiotics the bill at the pharmacy was 45,000 Shillings (the equivalent of ~$30).  Given that most Tanzanians make less than 5,000 shillings a day this family was unable to pay and so Dr. Swanson and I split the cost for the medications.  I only hope that when the time comes for refills they will be able to do so on their own.  I am having them follow up with me in two weeks so I will let you know how he is doing. 

We do often walk home and when we do we are always called into the home of an elderly man sitting on his porch.  He has severe bilateral lower extremity pitting edema, JVD, and a necrotic ulcer on his calf.  We gather from these findings and what we can understand of his Swahili that he was diagnosed with diabetes, hypertension, and heart disease but only was able to pay for one month of his medications and has not been seen in clinic since.  He is such a sweet man and clearly is suffering despite the fact that the hospital is a 20 minute walk from his house.  Treatment and monitoring of chronic medical conditions is something that we struggle with even in the US, however in Tanzania it is profound.

We spent our first weekend here in the Zanzibar archipelago.  Stone Town is the main city.  It is a UNESCO World Heritage Site due to its being a former center of spice and slave trade and it is rich with diverse influences of Swahili culture with a mix of Arab, Persian, Indian and European influence.   We spent most of our time soaking up the perfect weather and relaxing on the beaches of Jambiani. 
 
Beaches of Jambiani - Tanzania.JPG
This is actually a real picture I took

I have so many more stories to tell but I need to finish packing.  Tomorrow morning we head out on a three-day hiking expedition up Mt. Meru, a volcano that looms in the distance at 14,800 ft. Can't wait!

-Danielle