Here's what I'm doing

I finally found out what I am going to be doing! I met with Eric on Friday after our meeting was delayed all week for various reasons (flight issues, demonstrations, the usual). His study is comparing two ways in determining when to start infants on antiretroviral therapy (ART). Generally, babies should be started on ART asap. The participants were recruited from the inpatient wards and have been exposed to HIV through their mothers. Since infants have their mother’s antibodies, the rapid antibody tests cannot be used - tests must directly detect the presence of HIV.

The 2 arms of the study are the standard of care and point of care RNA tests. Right now, the standard of care is that babies are HIV tested with dried blood spot DNA PCR that is sent to a government lab, but this test takes at least a month to get results back (meaning increased chances of the patient being lost to follow-up). Whether to start the infant on ART is determined by whether the baby is symptomatic and then given a presumptive diagnosis.

POC RNA tests are not yet available but will be soon. The UNC Project lab, however, can turn over these lab results in about 48 hours. Since the participants are inpatient, this method is being considered as POC for the purposes of the study. These tests mean that an HIV diagnosis can be given immediately and ART can be started, but they are more expensive and require higher technology. When the test comes out, this study could provide valuable information on whether the government should change their policies.

What exactly will I be doing until December? In the mornings I am going to shadow and get some clinical experience/exposure (I even get my own stethoscope!). If I get bored, I can also organize other things to do, maybe see some surgeries or find a way to make some money. Then (after a 2 hour lunch break, score) in the afternoons I will be working on the study database and entering in data. Although this part will probably be tedious, I think it will allow me ways to figure things out, learn about clinical research, and hopefully give me ideas of other ways I could contribute to the study. 

Democracy in action?

Malawians protested against the President Wednesday (7/20) in the 3 major cities – Lilongwe, Blantyre, and Mzuzu. From what I understand, this is what happened (or you can google it) though I am incredibly skeptical of everything I have heard, including the sensationalized and underplayed.

Smoke from burning tire blockades, as seen from the guest house.

It was intended to be a peaceful demonstration criticizing recent power plays by the President/administration, the complete lack of fuel (and foreign currency to buy it), poor economic policies, the absence of medicines at the hospitals, etc. The night before the demonstration, the courts put in place an injunction banning demonstrations. I awoke that morning to sirens blaring around the city. The riot police were out in full force that morning arresting people in the streets and anyone wearing red (the color of the opposition). Later that morning and throughout the day, we could hear jeering and gun shots from the guesthouse, and there was smoke in the air from where people were burning the police’s tire barricades. We heard through the grapevine that the police were using tear gas, were beating people and many bystanders were getting hit by stray bullets. People were burning down police officers’ houses in retaliation. The violence lasted until yesterday when the army moved in.

Needless to say, I stayed at the guesthouse. I’m safe! Don’t worry!!

What is interesting is that the people protesting were exercising their constitutional right to peacefully demonstrate. The President, however, compared these actions to those of Satan and declared that he had the power vested in him by the Constitution to maintain peace in the country, which apparently means squashing dissenters. Every Malawian I have spoken to seems really frustrated by the state of things in this country and the direction it is going in. People took a stand and it seems like some news outlets actually picked up on it, perhaps the government will be held more accountable. 

Hello! Moni!

Hello!

UNC guesthouse (note the volleyball net)

Sorry for the delay – I’ve been getting situated. For example, I was at the bank for 3 hours one day opening an account (I should have brought lots of cash…). Lilongwe so far is great but COLD (its winter)! There is currently a fuel crisis (Lilongwe is practically dry), making getting around town a little difficult and our weekend plans are now up in the air since we might not have enough gas to leave the city.

My room (Mom. I know it's messy.)

I’m staying at the UNC guesthouse, which is right on the Kamuzu Central Hospital campus where I will be working. The guesthouse is great – I have my own room, there is hot water, satellite tv, wifi, and since we are on the hospital power grid our electricity isn’t always subject to the rolling blackouts (plus we have a generator just in case). If I’m going to be here for a year, might as well be comfortable. There are also 4 other students/fellows here at the moment. They are leaving soon, but the year-long trainees will arrive sometime in August I think.

A glimpse of Kamuzu Central Hospital (KCH)

The PI (Eric) on the study I will be working on (to be discussed next week) is on vacation, so this week I have been tagging along with one of the study clinicians, Mada. I sit in on the outpatient and inpatient check-ups, which pretty much consist of taking the baby’s temperature, weight, blood pressure, and counting pills to determine adherence. To weigh the baby, the mother first stands on the bathroom scale (weight is recorded), then she stands on it with the baby. I was in charge of determining the difference (I’m so useful!). We also see a set of preemie twins in the nursery – my new favorite place since its really warm.  Today I went and checked out the STI clinic, I loved it! The clinic is pretty much run by UNC Project staff and they are doing some really neat studies on acute HIV testing (antibody vs RNA tests) and social networking.

Other fun tidbits:

• I went RUNNING the other day for like 5 minutes and survived (sort of).
• I’m back on a honey craze
• I’m back to being called Maddy (ahem Edinburgh people) since Madeline is kind of hard for people to say
• I need to learn to check expiration dates. The grocery store doesn’t…