So, what am I actually doing out here??

Yeah, so I know you're wondering, "Why exactly is the U.S. government funding you to be in Tanzania for a year?!?!" This is probably the only entry that I can legitimately claim lateness in posting due to actually being busy with work!! But at least I should explain what I'll be doing next year... and then hold myself accountable for actually accomplishing something, 10 months into the future.

(For all those of you living life in Moshi vicariously but not so interested in research, this is where you can happily tune out :))

This is KCMC

So it turns out that I'll be doing a multitude of random projects, which seems like it could be totally discombobulating, but actually, it fits my multi-tasking, quasi-schizophrenic thought process and need to be busy... and believe it or not, my research goals. I'll spare you some of the details, but the gist is to understand the intricacies of clinical research, especially in a developing world, and to participate in various projects at various stages of the research - for example, idea generation vs. data collection and analysis vs. paper-writing. And of course, to be involved in projects on many different topics in women's health, so that I find my passion within this huge field.

Some background first -- it's hard to get one single project done in 10 months, from inception to completion, because of the inherent pace of the research everywhere as well as the roadblocks in Tanzania, intended and not. Being a foreigner proposing novel research here is incredibly difficult, time-consuming, and just plain bureaucratic. Then, there's always the unanticipated delays like no internet, getting data, being caught up in some other clinical activities, etc. So, that narrows down feasible research options to pre-existing, nationally-approved projects, retrospective data analysis, or quality improvement projects. With that said, here's a brief description of some of the projects I'll be working on (and some pics of my office) ... I know, the list is long and ambitious...

(and by the way, since there are no good pictures for this post, i'm adding mostly random ones).

My office

(1) Why do women with a history of domestic violence come to an HIV testing center? Are their reasons for seeking this service different than women who've never experienced domestic violence? For this project, the data has already been collected and I'm just the Stata monkey, analyzing the data and hopefully finding a unique relationship. Believe it or not, I actually like programming, so this will be a quick refresher course in stats and writing code... made even more fun since I can work on this remotely, ie from a coffee shop or under a tree in the middle of a field somewhere :)

(2) One of the huge studies here, being led by Duke, is a 4-year prospective study with over 1,000 people looking at the relationship between trauma, life stressors, other negative life experiences, sexual risk behaviors, and HIV status and medication adherence, to understand the barriers to taking HIV medication appropriately. We thought this would be a great opportunity to ask many people in the surrounding region about women's health issues -- contraception use, female autonomy about fertility preferences, health outcomes during pregnancy like miscarriages, stillbirths, child mortality, access to quality health care, and even the attitudes of men towards contraception and knowledge about HIV. I'm really interested in the contraception issues -- what women choose to use, what they'd like to use, whether they have a choice in using contraception or not, and how the psychosocial variables affect these questions. So we're adding a ton of questions to the survey and will get data back almost at the time I'm leaving in May/June, so it will be a mad dash to the finish line!

Lawn-mowing here, machete-style

(3) As you've probably seen from previous postings, women die here needlessly. It's awful. But one of those reasons is no blood! So with my new and young enthusiasm for a blood drive and Jeff's similar longstanding desire, we're going to start a blood drive primarily for the mzungus among Moshi residents (there are a lot!!)... and an O-negative registry as well, because since they are the 'universal donors' of blood, it's always hard to find. Did you know that O type blood is most common in the world, around 38%!?!? It doesn't make sense because it is a recessive trait. Characterizing the blood types here would be such an interesting project!! (and, I guess, if you stretch it far enough you could say it's a women's health project, but there's no time to do everything.) Anyway, so that's my goal this year -- to create a model for mzungu blood drives that are self-sustaining. My idea is to do it at the Watering Hole, the mzungu bar, and give everyone free movie/beer passes, but not on the day of donation!!! Sadly, I can't donate, my blood count is too low for their cut-off, but getting a lot of people to donate is a far better service. So even though this isn't research, this is probably the project I'll be most happy about achieving!!

(4) As a companion project, I think we're going to try to assess the accuracy of the clinical assessment of anemia compared to a lab measurement. You're probably thinking, why don't you just rely on the lab?? Well, here, the lab is totally unreliable!! You never know when you'll get the data back and even if you do, you have no idea how accurate it is. I don't think people can survive on a hemoglobin of 2. But apparently our pregnant patient was. Obviously she was low and needed a transfusion, but there are some patients for whom they are on the borderline of needing a transfusion -- so if you couple the lack of blood and the concern to 'save' it for a possible post-partum hemorrhage later that day with the lack of certainty about a laboratory value, you can see why being good at a focused physical exam for anemia is a great skill.

(5) I know, you're thinking, more projects?!?! Don't worry, this one is also data crunching, but happily, it's totally different -- infectious diseases -- and really interesting!! (for all those of you gunning for me to go into Medicine). So there's also a large Duke-HIV collaboration out here, and they recently did a study of patients presenting with febrile illnesses and looked to see the pathogens causing the fevers. Surprisingly they found that non-typhi salmonella (the kind of salmonella that doesn't cause typhoid fever) is really common, but they also found much higher than expected prevalence of leptospirosis and q fever (both bacteria). And just recently a paper from a very prominent ID guy and advocate for research on neglected tropical diseases, Peter Hotez (who spoke to us at Fogarty training!!) said that there is no known prevalence/epidemiology data on pathogens like this in sub-Saharan Africa. So one of the smaller projects in this huge study is to look at the clinical and lab characteristics of patients with these diseases -- and that's where I come in :) My PI on this project is definitely ambitious -- he wants it complete and accepted for a presentation at a meeting in 9 months!

(6) The last one is a bit iff-y -- depends on whether I need national IRB approval, at which point it will be a no-go. But basically, we'll be looking at a 6-year registry of cervical cancer screening clinic patients and seeing what the data shows. This is actually one of the most interesting projects because cervical cancer is huge -- out of the burden of disease cervical cancer poses worldwide, Tanzania is the most affected country. Can you believe it? And with proper screening and early treatment, it's curable. Yeah, exactly! So hopefully we get this project approved, but since I'm a foreigner starting a new project, there could some serious roadblocks.

Random flowers bloom on my way through the field to work

Sooooo, that's the round-up of my anticipated research life for the next 9 months. It should be awesome!!!! And I think mostly doable, barring some unforeseen roadblocks. I'm really, really excited!! And hey, I'd love some feedback on these research ideas -- like the "I wonder if..." thoughts that ran through your mind as you read this (if you made it to the bottom).

One day I'll learn to write succinctly....