Quick side-note, for those of you who are not familiar with the research project I am working on, here is a brief run-down. Currently Dr. Bangsberg is monitoring how well HIV infected patients are taking their medications. He is doing this in a couple of ways. The main ways are by distributing a pill bottle that has a special MEMS (Micro ElectroMechanical System) cap that records when the cap is opened. The data is stored in the cap until a Research Assistant travels out to the participant's house and downloads the data onto a laptop. While the RA is at the participant's house, they also manually count how many pills the participant has left and compares that to how many they should have which is based on what type of medication they are on. The RAs also verify that the participants have continued to pick up their medications from the pharmacy. The MEMS data is then brought back to a data manager who compiles all of the data. As part of my study and using some of my super sweet excel abilities (passed on to me by a Mr. Jeremy Beck of Chatham Partners) I was asked to analyze some of the data collected to see what types of interruptions are occurring for participants as they take their medication. I found, as expected, that there have been many short interruptions of about 2-3 days and a handful of long interruptions, some lasting up to 100 days. The issue with these interruptions is that the HIV virus has an opportunity to rebound and become resistant to the drugs being administered. This is a problem all over the world, but especially here where there is a limited number of drugs that patients can switch to. It only takes 15 days of missing ones medication for there to be a 50% chance that the virus has become resistant. And in as little as 5 days the likelihood is around 20%.
My study will attempt to find a way to identify patients who are missing their medications in real-time, as opposed to identifying the patients and the interruptions only after the fact, during one of the home visits by the Research Assistants. To do this, we will be attempting to use a new pill cap that not only will record when the cap is opened, but will also send a message back to a computer server in the office. We will set up alerts to inform us when someone has missed their medication for more than 48 hours and will then send someone (not me) out to find the participant and interview them about the past few days, with the goal of figuring out what exactly is causing these interruptions (transportation issues, money issues, food, water, religious...). This study, however, will only be a pilot study. This means we will only be recruiting 50 participants. The reason for this is because it relies heavily on the phone towers and technology, we want to make sure it is feasible and can be done out here in rural-Uganda. If anyone has any questions about this, feel free to shoot me an email or we can discuss when I am back in the States on Dec. 26th.
So, back to the update. While the research is pretty exciting and cutting edge, I again want to get out of an office and see the villages and communities and to work with the people there to help build local capacity so that projects and work can really continue without the supervision of American volunteers. In searching for such projects, I have been able to get in touch with the Director for the local Millennium Villages Project in Mbarara who is in charge of the MVP projects around South-Western Uganda. For those of you not familiar with MVP, it is Dr. Jeffrey Sachs' (a one time Newton Resident) approach to helping to reach the Millennium Development Goals which are long and I will leave to you to look up. A simple google search will give you enough info. Basically the projects aim to help build infrastructure and local capacity. They are still within their first 5 years and are now starting to think about the next 5 years, which will aim to include an exit strategy to hand over the management of these projects to the local governments. There is a lot of debate about the approach and many people think it is all baloney. I will spare you my thoughts for now, but it definitely has a lot of issues it needs to sort out.
My friend is working for them here and is actually based out in a small community called Ruhiira. He is working on setting up an electronical medical records (EMR) program for the health clinic there. He invited me out to see the clinic and see what is going on out there. The clinic is the most beautifully situated health clinic you can imagine. Positioned on the top of a hill, looking out over banana plantations and many more hills and green countryside. It has a beautiful garden and clean facilities. The health clinic, however, is lacking a lot of supplies and only has 3 in-patient beds. It is currently classified as a level 2 clinic, but is operating as a level 3 clinic as they do have a maternity ward (by ward I mean concrete room). Things are operating smoothly though, and the doctors have been very welcoming of the EMR system as prior to that, the only way of tracking patients previous health history was through blue journal books that I used to take final exams at Colby. Patients were told to carry these around with them whenever they were going to the clinic and theoretically, doctors would be able to look through the books to get the patient's history and the patient could take it to any health clinic. However, not surprisingly, patients would typically buy a new blue book before going to the clinic and then would pass the blue book onto their children to use in school and the doctor's notes were lost. Now, it will hopefully all be on the computers...if only America could get their act together and actually do this a bit faster...
Anyway, in talking to the people at MVP, they did say that they could definitely use some volunteer help 1-2 days a week if I was available when I come back, so right now this is a possibility for other work I could come back to work on.
Another big event last week was the end of the semester at Mburara International School. As such, last week was filled with games, movies, and presentations. The presentation for the parents occurred last Friday morning. Each class put on a presentation covering a different topic. Each class had been working on it all term. Junior Kindergarten presented about farm animals, Senior Kindergarten along with P2 presented about the importance of water, P1 presented about games and sports, P3 - Scouts and Scouting (like Boy Scouts stuff), P4 - the eyes, P5 - importance of a balanced diet, and P6 - Circulatory and Respiratory Systems. They were all great, but I think Junior Kindergarten "won". How can you beat 2-4 year olds miss pronouncing the names and sounds that farm animals make. Not to mention the performance of hoola-hooping they put on. They stole the show. Afterwards, the teachers gave out several awards and presented me with a beautiful African drum for having helped out at the school. Extremely unexpected and I was very grateful. I really had a great time at the school and will miss the kids and teachers a lot. They are now on holiday until Jan. 5. A full month.
(Warning: The below my be a little graphic for people, especially vegetarians like Ross Lohr)
However, it wasn't quite goodbye to the teachers yet. Saturday morning I woke up at 6 AM and caught a ride over to the school. We were having a goat roast and I had requested that I help out like all the other teachers. This meant I got to slaughter a goat. It was ridiculous. They wouldn't let me make the first slit in the throat, but very soon after that I was down there slicing the head off. Next, I was skinning the goat. I caught on pretty quickly and the Ugandans were pretty impressed with my ability to not leave much meat on the skin. They are very careful to use every part of the goat. I soon found out they meant every part of the goat.
Once the goat was skinned, one of the guys began chopping up the goat with a machete while I went over to help clean out the stomach and intestines. That's right, plenty of undigested grass and everything. We squeezed the feces out of the intestines, rinsed them with water, and then tied them so they they would cook more easily. I was given a brief tutorial and examination of the heart and just about everything else. Just when I thought we were done, they realized they had forgotten the tail. They quickly cut the meat of the tail. Normally they would also get the meat out of the head and use the hooves, but there are 3 or 4 dogs that live at the school so they were going to let the dogs enjoy the head and hooves.
We chopped up all the meat and passed some of it onto the women to prepare stews and such, while the majority of the meat was slightly seasoned and thrown onto skewers over the grill. The afternoon consisted of consuming large amounts of goat meat and plenty of beers. There was a short dancing session as the meat and beer started to wind down. Some rain moved in, so we moved inside and chatted and listened to music for a little while. It was a great afternoon and a final goodbye to many of the teachers. At least a temporary goodbye. I got a ride home and was all ready to have a relaxing evening when Connor and crew called me up and invited me to a wedding reception, which I actually mentioned in the last post. I met them at the wedding, not knowing who had just been married. We then proceeded to have some more drinks (including some Waragi which is the local gin produced from the bananas. It isn't too bad actually.) We danced with Ugandans all night and took over the dance floor and had a great time. The weddings here really are just about celebrating. Anyone and everyone is welcome really. They don't have open bars or food at the reception party, but they apparently did at the actually wedding part.
It was one of the best Saturdays I can ever remember having and I am sure it will stay with me for a long time to come. The next day was to be the beginning of my short tour of South-Western Uganda including tracking the mountain gorillas. The next post will cover that trip and probably my last few days in Mbarara. Until then, take care.
No comments:
Post a Comment