Hey y'all!
I apologize for the delay on the new post, I was almost done with it when blogger crashed, losing about half of what I had written...but all is good and we are back!
I apologize for the delay on the new post, I was almost done with it when blogger crashed, losing about half of what I had written...but all is good and we are back!
Since most of our posts have been more about the social scene here in Lilongwe we wanted to post a little about the work we have been doing as well. Suz and I visited a couple of UNC research studies taking place at various sites around town.
We started off visiting Bwaila hospital where UNC is running the PROMISE study (Promoting Mother and Infant Survival Everywhere). The purpose
of the study is to examine effective methods of preventing
the transmission of HIV from mother to child during pregnancy, labor and
delivery, and breastfeeding by starting women on one of three antiretroviral regimens. Suz and I mostly observed during our time with PROMISE as most everything is done in Chichewa with many of the women speaking little to no English. We watched study visits with pregnant women and new mothers and assisted with scheduling follow up appointments. We also got a chance to see how PROMISE recruits study participants. A few nurses from UNC Project head up to the maternity unit at Bwaila just a short walk up the road. Here they assist with what is essentially the first prenatal visit where pregnant women anywhere from about 8 to 24+ weeks come. The women receive basic prenatal care including routine vaccinations, vitamins, weight and blood pressure screenings, palpation to determine gestational age as well as pre and post test counseling and HIV testing.
Bwaila Maternity Ward, 1 of the newest buildings we have seen, built in 2010
Suz and I both agreed the system was amazing. Flocks of close to 100 women arrive early in the morning to line up and start their long day at the hospital. Women wait patiently moving from an outdoor shelter area into one room after another where they wait on long benches for their turn to have their blood pressure taken, have their weight measured and growing bellies felt, as well as receive numbers for the HIV testing that will take place later in the morning. After this the women are split into two groups for a pretest counseling and HIV information session, one of which happens outside under a UNICEF tent with all the women crowded in and sitting on a tarp on the ground. This session includes information on what HIV and AIDS are, the difference between the two, how HIV is contracted and how one can prevent it. Information is also provided on how the testing works and what it means if the test comes back positive. Lastly the women are told about the choices of a antiretrovirals they will receive if they do in fact come back positive. Here is where they are also given details about the PROMISE study.
Our testing area. Each blue/red/green card has 10 individual rapid HIV tests on it.
One after another, women sit for a finger prick, the nurse places a few drops a blood on the test, adds buffer and watches it run. 1 line = negative, 2 = positive. The whole process takes less than a minute for each woman, with the tests being read after about 15 minutes. Of the 84 women tested the morning I was there, 12 came back positive, with 8 of those being new positives. These women would then be told of their status and counseled as to what the next steps would be. Women who do not go on PROMISE are immediately put on HAART (highly active antiretroviral therapy) and will remain on them for the remainder or their pregnancy and life. If they do choose to join the study, they will have various tests run such as viral load, CBC, CD4 count, and chemistries. They will then be put on one of three ARV regimens and followed throughout their pregnancy and up to two years after the birth of their child. Women benefit from being on PROMISE by receiving routine prenatal care as well as various lab tests throughout their pregnancy and HIV testing for their baby until their final status is determined, usually about 18 months.
One of the aspects of this study that was very interesting to me was that the nurses do not tell the participants about the possible benefits of joining PROMISE until the screening visit for eligibility. When I asked about this, one of the nurses told me it would be coercive to tell the patients about the benefits they may receive. This is very different from all the research I have been involved in as we let people know almost immediately about what they will get in return for participating. It makes me wonder how many people would actually participate in research in the U.S. if they weren't informed about benefits and/or payment for their time.
One of the aspects of this study that was very interesting to me was that the nurses do not tell the participants about the possible benefits of joining PROMISE until the screening visit for eligibility. When I asked about this, one of the nurses told me it would be coercive to tell the patients about the benefits they may receive. This is very different from all the research I have been involved in as we let people know almost immediately about what they will get in return for participating. It makes me wonder how many people would actually participate in research in the U.S. if they weren't informed about benefits and/or payment for their time.
Suz and I with some of the UNC PROMISE study nurses
We also spent some time at the Malaria Vaccine Clinic in Area 18, about a 10 minute drive from the hospital. Lilongwe is split up into areas much like districts but as far as I can tell are there is no logical ordering to the areas, ie: Area 18 is next to Area 31 which borders Area 42...you get the picture.
UNC Project runs a GlaxoSmithKline sponsored phase III clinical
trial that is looking at the efficacy of a Malaria vaccine in 2 groups of
children, ages 6-12 weeks and 5-17 months. The trial started in 2009 and has enrolled
over 1600 children. Right now the trial involves giving booster shots and
seeing kids for sick visits and drawing blood in order to diagnose and track
the rates of malaria. Families benefit from the trial as their children receive
the vaccine and boosters as well as free medical care when the enrolled child
is sick. On average, children in Malawi get malaria 2-3 times each year so the
clinic is a welcome addition to the area.
Suz and I spent about 3 days at MAVAC and helped by running
charts between clinic rooms, taking vital signs, and trying to distract small
children during blood draws (mostly unsuccessfully). We were also given the
opportunity to draw blood. After watching one of the nurses work her magic on a
screaming infant and effortlessly collecting a tube of blood, she then informed
me it was my turn. As some of you may know, I have only drawn blood ONCE IN MY
LIFE. And that was on Suzann, whose skin
is as translucent as rice paper. Last fall. Needless to say, I was more than a
little nervous.
As I rigged my tourniquet (aka a rubber glove) on the little
boy’s arm he immediately knew that I was coming for him with a needle. The
screaming and crying commenced, Suz tried distraction, his mother held his
feet in between her legs to stop him from kicking, and tried her best to keep his little arm straight and
all I could say was "pepani,"a failure at an apology in Chichewa which clearly
meant nothing to this 2 year old boy. After attempting to feel for a good vein
and taking a deep breath, I dove in. Miraculously, it worked! The blood flowed
despite all the odds. As you can probably tell, I’m pretty proud of myself...
Some of the clients awaiting medicine in the nurses station at MAVAC.
Other than our crash course in phlebotomy on 2 year olds we
also had quite a few other highlights from the MAVAC clinic. Some of these
include: checking out malaria parasites under the microscope, observing IV
insertions, and watching various venders parade into the nurses station selling
their wares-corn meal, green peas, okra, turnip greens, peanuts, as well as non-perishables
like wigs, bibles, nursing uniforms, and slips. Here in Lilongwe it is
completely acceptable to stop what you are doing, whether its checking in a
patient or administering medication, check out the goods being sold and bargain
for a better price. Suz and I also got to spend time trying to entertain
kids while they waited to be seen for their visits. We soon realized that
smiley face stickers made from medical tape were the way to go when trying to
get a smile. Who needs language in common when there are stickers?
One of the other great things about the clinic was getting
to know some of the nurses and being invited to eat their traditional lunch of
nsima, stewed tomatoes and greens with the occasional bit of meat or boiled
egg. You eat this by rolling the nsima (Much like grits. Read more here: http://en.wikipedia.org/wiki/Nshima) into a small patty in your hand and picking up the other food with it. Everyone gives a bit of money at the beginning of the week and then the
clinic aides buy food from the local market and spend time each morning cooking
out back behind the clinic. Each day at noon, the majority of the staff gather
upstairs in the break room and join in on the communal lunch. While I was a
little leery of the ingredients and cooking methods, I joined in with a smile
on my face and my water bottle near by.
Me trying out our tasty meal. Thanks Suz for your expert photography skills!
Suz and I enjoyed our time at the MAVAC clinic and really
appreciated the warm welcome the clinic staff gave us. We even became facebook
friends with a few! We are fortunate to be rotating through various UNC Project’s
sites and like seeing all the different research UNC has a hand in.
Hope everyone has a wonderful week and we promise to post
again soon! Happy Father's Day Dad!
-Jen
So many new experiences for you, Jenny. l enjoyed reading about your activities (well.... except for the blood drawing, and you know my squeamishness about that!) I wasn't aware of all the work UNC is doing to prevent malaria and the transmission of HIV. Glad you and Suzann can be a part of those efforts.
ReplyDeleteSmiled the whole time I read this post! You two are having so many amazing experiences!! Way to go for joining in the traditional communal lunch! :)
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