WOAH. August is over?! It’s hard for me to be in denial any longer, especially since my first day of Senior Year is tomorrow! My last fall semester Shopping Week is kicking off in just a few hours and with three years of wisdom and experience as an undergraduate, I’m still frantically constructing a shopping schedule the night before…
Shopping Week is what we call the first week of every semester when students are allowed to sit in (or walk out!) of any and all classes without any hard feelings. It’s an exploratory week where everyone strives to strike the perfect balance of our favorite professors, homework, and catching up with everyone back on campus! Although I don’t have a shopping schedule yet, I’m not exactly freaking out because we pre-term plan (PTP) which is a system where students enter courses they intend on enrolling in for the next semester in advance. Both Shopping Week and Pre-Term Planning have no strings attached which definitely eases the stresses concomitant to committing to classes!
But before we get too serious talking about commitment and classes, I wanted to wrap up my summer of participating in iSURF (international Summer Undergraduate Research Fellowship) through the Global Health Institute. I was pursuing clinical research in maternal health and nutrition in Dar es Salaam, Tanzania for a total of 9 weeks. I wrote a final report at the end of the program that I wanted to share with you – below is what I submitted!
Nutrition and Global Health Internship
Muhimbili University of Health and Allied Sciences
Dar es Salaam, Tanzania
The summer internship abroad description depicts clinical trials addressing critical gaps in nutrition and the complex dynamic between these gaps and infectious/chronic disease as well as perinatal, child, and maternal health. The core of these epidemiologic studies entails randomized clinical trials investigating both the safety and efficacy of iron and/or vitamin A supplements during pregnancy in resource-poor settings, with the ultimate goal of positively contributing to the broader global health and health policy agenda.
I am pleased and happy to report that all of these promises of both wide-range and in-depth clinical research exposure that was laced within the internship description were successfully delivered upon completion of the internship.
Although my Tanzanian internship was my first time traveling to the African continent, this summer internship was not my first abroad experience. I spent last summer abroad in Latin America, completing a medical shadowing internship at a private clinic in Lima, Peru as well as a sustainable clean water engineering project in Cochabamba, Bolivia. My South American experiences last summer have imprinted an understanding of the slower pace traditional outside of state lines and most importantly, have honed my patience as well as my ability to both appreciate and adapt to the culture of my surroundings. For my African adventure, I anticipated similar communication barriers and delays concomitant to the abroad lifestyle. To my pleasant surprise, the task list accumulated at a beyond reasonable pace whether that entailed acquiring familiarity with the three studies or advancing the trials along.
My first task involved creating a Standard Operating Procedure (SOP) to regulate and track the flow of participants’ samples and data. The SOP task emerged from necessity as it seemed as if neither a written nor digital record existed; but coincidentally and conveniently, investigating informational flow through shadowing and interviews served the greater purpose of learning the details of the study and its data collection protocol. It was interesting to peak into, poke around, and then ameliorate the gap in procedure. Unlike a laboratory bench experiment, clinical trials are more vulnerable to uncontrolled and unexpected events which call for resiliency and flexibility in problem solving. This realization was also enlightening because it was my first time differentiating between protocol and practice. I admire the type of on-your-toes need for creativity that has proven to be characteristic of working in big scale clinical trials.
Drafting the SOP harmoniously worked hand in hand with the assignment of creating a matrix which visually juxtaposed the study’s various analytical laboratory tests with how the test results are utilized to determine the health conditions of participants. The completion of this task necessitated research beyond the studies’ full protocols. Scientific journals and research articles helped me not only compile the test-condition matrix, but also develop an understanding to the meaning behind once abstract large words and fancy acronyms. It was refreshing to get a big picture sense of the study as well as its details to motivate both the clinical trials and my personal contribution, especially since it is very easy to have research interns work with their heads down without grasping the grander purpose of neither their labor nor the study.
Speaking of working diligently with my head down, I brought it upon myself to familiarize myself with the Microsoft Office program of Access, software that I never heard about before this nutrition research internship. Access serves as a relational database management system that also catalyzes the export of data for analysis. I concentrated on creating Access forms for a different study that also examined maternal health called Cook Smoke with Blair Wylie as the principle investigator. My practice of creating Access forms was quickly put to good use for developing a Compromised Sample Log form. However, creation of this form catalyzed the realization that the LIS database currently in use needed to be revamped to optimize efficiency and cease disappearance of data. A Visual Basic database has been piloted and activated with intentions to record laboratory test results.
The backlogging of the first 6-7 months of 2013 has been initiated and is well underway with the new database. It is easy to perceive repetitive tasks such as entering data or counting slides and blocks as useless, time-killing tasks. However, I tried to keep an optimistic mindset because as minor as my tasks seemed on the surface, they needed to be completed in order to move on to later stages of the study. It is important to experience first-hand multiple aspects of research so that a broader sense of perspective can be more easily achieved.
With a familiarity of both a broad and narrow sense of the trials, the opportune time to visit hospital sites presented itself. I enjoyed and appreciated the diversity of the sites – some sites are located in popular, urban areas while others pop up from unpaved compounds. The drastically diverse landscapes of the sites directly reflect the wide socioeconomic gaps in Dar es Salaam’s population which is an important characteristic to include and analyze within the trials. On-site visits were exciting and eye-opening as I tried to observe and memorize every detail of the hospitals. From the common waiting room to the labor waiting room and all the way to the actual birthing room, I was entranced by all the similarities, but mostly differences, to American and Peruvian hospitals.
The hospital differences grew – in a depressing manner – with the opportunity to shadow Professor Ferdinand Mugusi at the non-paying infectious disease ward of Muhimbili Hospital. Regarding my hospital exposure, my experiences have been relatively sheltered due to high US health standards. Even when I served as a medical shadowing intern in the developing country of Peru, I was based in a private clinic where financial concerns were neither a prominent thought nor a driving factor in every patient diagnosis. Tanzanian physicians tend to favor the cheaper, more non-specific tests, if any tests at all. It is indeed inspiring to witness Tanzanian provisions of free health care to those who cannot afford it. However, it is also distressing to witness crowded conditions within an infectious disease ward where resources are extremely limited. The silver lining lies in the uplifting reassurance of how well the staff strives to evenly distribute the resources available.
As with any developing country, Tanzania is no different in that financial matters both motivate as well as limit its progress. It was ironic how financial constraints also influenced the smooth advancement of the clinical trials. I have experience with money trouble in the context of laboratory bench research and grants, but I have never seen – or have I ever been this moved by – a staff that financially contributes out of their own pocket for the sake of keeping the study alive and running. To say that such efforts are heart-warming would be a grand understatement. Seeing first hand a non-romanticized perspective of research illuminated the people’s passion for their profession – a passion I arduously aspire for as an undergraduate – as well as wholly demonstrates the kind heartedness characteristic of Tanzanian culture.
Another important and intrinsic aspect of Tanzania is their skill to work in teams. During the weekly Thursday Skype meetings with Professor Wafaie Fawzi in Boston, it was always delightful to have everyone gathered in one room, catch up on the details of the study that they are personally responsible for, as well as work towards a common goal and brainstorm solutions to problems that have arisen during the week. The most personally impactful meeting was over the topic of enrollment and raising awareness about the maternal health studies. The catch 22 dilemma consisted of our goals to innovatively enroll new pregnant participants all while not overwhelming the clinic sites. Ideas to collaborate with individual village’s community leaders as well as hire a truck with a speakerphone announcement were debated. Although the solution remains in a grey area, the sound consensus was that the shared goal was to promote our study without demoting the reputations and perceptions of the health care system. The seamless transition from one specific problem of enrollment to the general concern of maternal health programs was a critical moment to witness because it served as a reminder to maintain awareness of each baby step so that in the end, the aggregation of steps creates a path to the ultimate end goal of improving global health.