doc w/ Pen

journalist + medical student + artist

Tag: research

April 8, 2018

Boxes, boxes, everywhere

My pile of “savory” snacks to bring to Uganda.

In a peaceful coup, Uganda has assumed control of my tiny, 1-bedroom apartment.

There are boxes everywhere …

A box of food. LOTS of food. I don’t consider myself a picky eater. But on my first trip to Uganda, which lasted 3 weeks (this one is a month), I discovered quickly that I wasn’t getting as much protein as I was used to. We had fruit, wonderful fresh fruit, but almost no vegetables — we can’t eat them unless they’ve been peeled because we can’t drink the water. In general, the diet there is very starch-heavy, which is not what I eat at home. As a result, I was also just eating less than usual. I’ve tried to remedy all that with an assortment of goodies that I’ve pictured here, separated out into “sweet” and “savory” piles on my kitchen table so you can see the variety. Some things are from Trader Joe’s, some from Amazon Pantry, some from my grocery delivery service. When I put everything into those piles, and realized how much I’d bought, I thought I’d gone overboard. I said as much to my research mentor, Dr. Randi Diamond. She didn’t think so. “Bring as much of it as you can,” she told me earlier this week. Luggage weight permitting, I will.

My pile of “sweet” snacks to bring to Uganda.

Not pictured here is the mound of coffee I’ll bring. I survived on tea last time, but it wasn’t pretty. I’m not in any way religious, except perhaps about my morning routine: coarse ground, brewed in a French press for precisely 5 minutes while my ceramic mug heats up too, filled with extra boiling water from my electric kettle. I add a little sugar and half-and-half, take a sip, and then, finally, can really take on the day. After some searching on Amazon, I found a travel French press that I’ve tested and found to pass muster. I’ll have sugar there, but no cream; refrigeration is iffy due to frequent power outages. It may be rough, but I’ll survive.

Boxes of our teaching guides. Twenty-five each of red, black, and blue plastic folders, the kind with metal prongs. One of my trip-preparation tasks has been to put the correct number of sheet protectors into the folders for each of our three modules (11, 10, and 9 sheet protectors, respectively), and then shimmy each printed page into each sheet protector.

One of the 72 little notebooks we’re bringing with us to Uganda, to encourage reflective writing.

A box of notebooks. I mentioned in my last post that in our teaching guides, we include reflection questions to try to get people thinking about how these lessons apply to their own lives and practice. We’re going to encourage discussion of their thoughts, as well as journal writing. So we’re bringing along 72 little notebooks, each with a sticker I’ve designed and stuck on identifying it as part of our program.

A box of surveys. This box holds a 4-inch-high stack of stapled packets, color coded in green and yellow printer paper so we know what’s what.

A box of office supplies. There’s no Amazon Prime in rural Uganda, no Office Depot, no Staples. So we’re bringing along our own stapler, scissors, paper clips, binder clips, pens, tape, a Sharpie, Post-it notes. Some of the items, we know we’ll need. Others we’re not sure of. But we might need them, and there’s no good way to get them in rural Uganda. So into the suitcase they go.

In addition to the boxes, I’ve also got some stacks going, and some piles.

There’s a stack of paperbacks I’m bringing with me, for my downtime. Due to limited suitcase space (and weight), I’m also downloading a bunch of audiobooks onto my phone.

Then there’s the pile of clothes and toiletries that I’ve set out to pack. Bringing everything you need for a month — but not so much that your suitcase goes over the 51-pound weight limit — requires some serious thought. Especially when you need to dress for multiple occasions. I’ll be wearing “professional” clothes (nice pants, a blouse, dress shoes) for the days when we’re out doing our research sessions at the various rural hospitals. I hope to head out with the Palliative Care Outreach Team too, during some of my downtime. On those days, I’ll wear casual clothes and tennis shoes.

I’m constantly stepping over these boxes, stacks, and piles; shifting them from kitchen table to desk to floor and back depending on what I’m doing and where I need space. But it’s a welcome merry-go-round, a constant reminder that exactly five days from the moment I’m typing these words, I’ll be at JFK airport, waiting to board my flight.

I can’t wait.

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April 3, 2018

Back to Uganda …

In less than 2 weeks, I’m headed back to Uganda for another palliative care research project. This picture was taken during my first trip there in July of 2016.

I’ve mentioned in several recent posts that I’m on a four-month research rotation. Then I realized that I haven’t said anything about what I’m actually doing. It’s time to change that.

Before I delve into the details of the project itself, though, I need to provide some background and context so that the project itself makes sense.

Those of you who have been following along for a while may remember that I went to rural Uganda in July of 2016, the summer after my first year in medical school. I went with a palliative care physician from Cornell, Dr. Randi Diamond, to do both clinical and research work, looking (in part) at the understanding palliative care patients there have of their illnesses, and why people present at such late stages of illness to the medical system.

One thing palliative care patients told us during that trip was that they perceived their health care workers to have poor communication skills. And as a result, the patients were distrustful of medical workers, and the health care system as a whole.

In rural Uganda, it’s also important to know that medical workers have limited access to continuing medical education (“CME”). Much of the palliative care CME (and CME in general, for that matter) is Internet-based. As I learned during my first trip there, even in places that have the equipment for Internet, it’s completely unreliable. Not only that, but medical education materials are mostly developed for a Western audience like ours — one with incredible resources. What’s discussed and taught isn’t always relevant to medical workers in rural Africa, who work in a very different environment, as you can see from pictures I’ve included below, taken during my first trip there. (If you want to read in more detail about the hospital environment in Uganda, here is a post I wrote about it in 2016.)

Surgical laundry
OPD (outpatient department).
Emergency room
Rural homes
Adult hospital ward

All of this got Dr. Diamond and me thinking about whether we could do something to help improve communication skills among health care workers in rural Uganda.

As did some things we learned from an organization we’ve now partnered with on this new project, the African Palliative Care Organization (APCA). APCA has developed its own palliative care curriculum for use in Africa, and one of the key competencies is communication. In developing this curriculum, they did a needs assessment, and found “communication” to be one of the gaps in both skills and knowledge in health care workers there. They also found a shortage of culturally appropriate materials for teaching palliative care.

Putting all this together, there is a clear need for culturally appropriate continuing education directed at communication skills.

Both Dr. Diamond and I found ourselves in a unique place to help fill that need. During Dr. Diamond’s last two summer trips to rural Uganda (2016 and 2017), a documentary film crew accompanied her and the local Ugandan palliative care outreach team on home visits to palliative care patients. So she has footage of palliative care taking place in rural Uganda, with local medical workers, that could be used to illustrate best practices.

As part of Cornell’s curriculum, I have 6 months to do full-time research, 4 months now and 2 months at the beginning of 2019. After my first trip to Uganda in 2016, I knew I wanted to work with Dr. Diamond again, and go back to Uganda. From my past life as a textbook editor and freelance writer, I also have experience in developing educational materials.

It was a perfect match.

In less than 2 weeks, we leave for Uganda to pilot test the multimedia educational modules we have developed. There are 3 different modules:

  • Basic Communication Skills in Palliative Care
  • Delivering Bad News
  • Pain Assessment (with a focus on the communication aspect of assessing pain)

Each module includes the video clips I mentioned, and a teaching guide that Dr. Diamond and I wrote. The teaching guides have educational content as well as reflection questions to get people thinking about how what they’re learning applies to their own lives, and their own patients. This kind of “reflective practice” is so important in palliative care (and all of medicine, really). It’s not done much in Uganda, but it’s something that APCA has identified as a goal for integration into medical education there.

To give you an idea of what we’ve created, here is a page from the “Basic Communication Skills in Palliative Care” module:

Here are the basics of our research design:

Hypothesis: Communication training with culturally appropriate modules will enhance health worker confidence in, and knowledge base about, communicating with PC patients.

Methods:

  • Pilot test the modules at 6 different rural sites in Uganda, identified by APCA
    • Hoping for 6-12 participants per site (targeting medical workers such as physicians, nurses, and nurse assistants who interact with palliative care patients)
    • Planning to test 2 of our modules at each site
  • Conduct pre- and post-intervention surveys to assess the effectiveness of the modules
    • Surveys will assess both knowledge base about, and confidence in, palliative care topics and skills
    • Future data analysis will measure whether there is a change in knowledge and/or confidence after the participants complete the module

This project is not just about research, though. It’s also about leaving something behind that people can actually use. At the conclusion of each pilot testing session, we will leave printed copies of our teaching guides, as well as flash drives with the video clips and the teaching guides in PDF form. Hopefully, this strategy resolves the access issue; while Internet is spotty, these rural sites do have computers.

I’m in full trip-prep mode right now: assembling the printed guides, survey packets, mosquito repellent, and lots of protein to take with me for the month I’ll be there (the Ugandan diet is mostly starch based).

I’ll be based at the same place where I stayed during my last trip, St. Francis Naggalama Hospital, working with the wonderful Naggalama Hospital Palliative Care Outreach Team. I will sometimes have Internet access there (hopefully, more often than not). As I do, I will try to post updates on my trip.

5 Comments
December 4, 2016

An abstract challenge

I first saw my name in print in the fall of 1999. It was my first semester of college. I had taken a journalism class because my advisor told me not to. When I fell in love with reporting and writing, my journalism TA hooked me up at the school newspaper. My first article was a feature on cider making at the local apple orchard.

That was 17 years ago. It’s still a thrill to publish — to share my written work with the world. These days, most of that takes place via this blog or the online magazine where I write a monthly column. Most of my work consists of personal essays.

But last week, I submitted a different sort of writing — a research abstract based on my work in rural Uganda this past summer. If the American Geriatrics Society (AGS) accepts my abstract, I will present a poster at the organization’s national conference in San Antonio, Texas, in May 2017.

I do have another scientific publication — a secondary authorship on a paper from the Drosophila melanogaster (fruit fly) lab where I worked for a semester while taking my medical school prerequisites. But this would be my first time as a first author. And this would be my first foray into the world of clinical research.

Acceptance here is by no means a guarantee. And my topic is somewhat outside the typical AGS fare, so I’m not holding my breath. Even if I don’t get accepted, going through the abstract writing process was still a wonderful experience. Distilling all that work into fewer than 2,650 characters was something else. That taxed even my editorial expertise.

All that said: *fingers crossed.* I’ll find out by February.

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June 19, 2016

Summer plans: Research and palliative care in Uganda

My visa to Uganda.

My visa to visit Uganda.

One of the reasons I was so interested in Weill Cornell is its emphasis on global health. This isn’t a passing fancy. I studied abroad in Valparaíso, Chile for a semester in college, and learned more about the world—and myself—than I imagined possible. My career goal during college was to become a foreign correspondent based in Latin America. And upon graduation, I earned a minor in international studies. All that is to say: global issues matter to me.

Things are a little different now. I’m no longer a journalist. I’m in medical school. But my interest in the world outside our borders hasn’t changed. So this summer, I’m spending three weeks in rural Uganda. I’m going with a physician from Weill Cornell who travels there every summer to help provide palliative medical care in a small hospital, as well as rural home settings. The organization that funds the work is called Palliative Care for Uganda. I’ve linked to the group’s website, which has pictures of the hospital and village where I’ll be going. I’ve seen the photos and heard the stories too, but I know I’m completely unprepared for what I will find there. I don’t know how I’ll respond or feel about what I see. My only expectation for the trip is that it will change me, and how I think about things.

The main purpose of the trip is to provide medical care. We will be rounding in the local hospital. Along with the hospital’s palliative care outreach team, we will also be traveling to people’s homes to provide care there.

While on a medical mission, we’re also on an educational mission. Many people in Uganda, when they become sick, don’t seek medical attention. So their conditions worsen and may become terminal. We want to understand why they don’t seek medical care early on when illnesses are potentially treatable. There are some theories, but none have truly been investigated in Uganda. We hope the information will be useful from a public health perspective down the road, but that’s not part of what we’re doing this summer. Specifically, I’ll be interviewing patients and caregivers in their homes. I’ll ask about people’s understanding of illness, for example, and what type of medical care they sought early on, if any. Separately, I’ll also interview the health care workers. We’ll see what we find.

While in Uganda, I also plan to take in some of the sights—hopefully a weekend safari.

It’s a short trip, only three weeks. But I know it will be a life-changing experience. I will have Internet access while there (at least periodically) so plan to write about those experiences as they occur. So stay tuned.

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July 28, 2015

Science Marvels #1

I dove back into science yesterday. My first medical school assignment is to complete a prematriculation assessment, and since I’ve been out of school for a few years (finished my coursework in the spring of 2012), I’m brushing up on some basic concepts along the way. In doing so, I quickly rediscovered the pure joy I find in studying science. To try and share that sense of awe and wonder, I’m going to post periodic amazing science facts or concepts on my blog. Here is today’s entry.

Electron micrograph of chromosomes from Berkeley.

Electron micrograph of chromosomes from Berkeley.

The Amazing Chromosome: Stretched out to its “contour” length, chromosomes range from 1.6 to 8.2 centimeters long. Yes, CENTIMETERS. This according to my medical biochemistry book. Holy cow! Question: So how do these linear segments of DNA fit in our tiny cells? Answer: They are condensed more than 8,000 fold, coiled and wrapped over and over with RNA and proteins called histones. Wow. Marvelous indeed.

October 15, 2013

Long-Overdue Update

Wow, I can’t believe how long it’s been since I posted here. So very much has happened. I’m almost not sure where to start. So if this becomes Faulkner-esque stream of consciousness writing, please pardon me; you’ll understand, I hope.

1. MCAT. My score (33 total: 10/PS, 12/BS, 11/VR) was not quite what I’d hoped it to be. My goal had been a 35. But it’s a decent score, more than a decent score, and with my GPA, ECs, LORs, etc. it makes me a very attractive candidate.

2. Applications.
– 25 schools in the primary round
– 23 secondaries (2 only give you secondaries if you get an interview, and I didn’t/haven’t)
– 4 outright rejections (but that leaves 21 still considering me)
– 3 interviews, 1 down, 2 to go (and the next is this coming Wednesday, 10/16, so wish me luck)

3. Money. This has been a sore spot, and a struggle, for me for the last couple of years, as I have written about here frequently. Paycheck to paycheck, sometimes not quite making it and having to ask for money (not something I like to do). Not because I’m a slacker, but because I took a very low-paying lab job for the experience, and my Joint Commission Resources freelance work (which is great pay) just couldn’t make up the difference. I had no idea how I was going to pay for applications (which, thus far, have cost about $3,500, and this is without any long distance interviews). Thankfully, I have some great people in my court, who have helped me make this happen. And then, I got a …

4. New job. Yep. Not that I was dissatisfied, work-wise, with my old one. Although it was only part time, and I didn’t have benefits (and my current benefits were to run out August 31, 2013). I interviewed for several positions, and finally landed one in Peds/Neonatology at Northwestern University Feinberg School of Medicine. Full time, higher pay, and benefits (which kicked in September 1 – talk about good timing). It’s been a great learning experience thus far. I do a lot of mice work as I did before, but LOTS more surgeries. And this time on itsy bitsy mice (hence neonatology). Cannulating the trachea of a 5 gram mouse is definitely a challenge in dexterity, but one I am mastering. We’re researching bronchopulmonary dysplasia and BPD-associated pulmonary hypertension, so it’s again lung-related which is interesting. One of my PIs is an MD/PhD, the other is an MD. It’s been good to talk to them both about academic medicine (they also do clinical work at the NU NICU), given that they took different medical degree paths to get to a combined practice/research situation.

Well, that’s a good summary for now. I’ll try to be better about updating …

April 4, 2012

My First Research Symposium

One thing I have learned about “being” in science is that it involves poster presentations. Some people like them, some people hate them, but they are a part of the job. I saw my mentor and supervisor at UIC, Olga, make several posters (to present at various conferences) while I was working there. And for the Drosophila genetics conference, Dr. Kreher made one as well (which I wrote about earlier, and which included me as a secondary author!).

Today, I will present my first and very own poster at Dominican University’s “Undergraduate Research, Scholarship, and Creative Investigations Expo” (“URSCI” for short). This is an annual event at Dominican, where students from across different disciplines present their research work through both presentations and posters. For the poster portion, which is what I am doing, you have a designated time that you are supposed to stand by your poster and explain it / answer questions about it to anyone who is interested. While this might make some people nervous, I am really excited about the opportunity. I love talking about science (obviously), and I am also adept at explaining it in more basic language for people who might not be familiar with the concepts or procedures. That is one thing I learned well in journalism – you have to know your audience. So I know how to tailor my explanation, based on the people with whom I am talking.

The title of my poster is “Antibiotic Resistance of E. coli to Rifampicin and the Mutagenic Effects of Caffeine.” The work stems from a project I did in my Research Methods in Molecular Biology class, which I took last spring with Dr. Kreher. (I am currently working in his genetics lab with the fruit fly larvae.)

Ecoli_Caffeine_LEM

It was a fascinating project, and it had two components. As a class, we reproduced the experiments done in the late 1980s by two researches, Jin and Gross. They investigated how E. coli develop antibiotic resistance to a drug called rifampicin, which is used for tuberculosis. Based on their research, and previous work, they determined that rifampicin inhibits the bacteria’s RNA polymerase (which is what transcribes mRNA, which is later used to synthesize proteins). That’s bad for the bacteria, because without the necessary cellular proteins, the bacteria will die. But Jin and Gross also discovered that the bacteria can develop, at a particular rate, specific mutations in the gene (rpoB) encoding for a particular subunit of its RNA polymerase. These mutations allow the bacteria to survive treatment with rifampicin.

We repeated Jin and Gross’s experiments, growing E. coli on agar plates containing rifampicin (as well as another antibiotic, carbenicillin, to which our bacteria had been engineered with a resistance gene, so that only the bacteria we were studying would grow – no random bacteria from the environement would grow, because the carbenicillin would kill it). We were able to generate resistant bacterial colonies as well, and sequenced their DNA. In comparing the sequenced DNA to the wild-type rpoB (RNA polymerase) gene, we found some of the same nucleotide mutations as Jin and Gross, as well as a couple of mutations that were unique to our experiments.

The second part of the project was to choose a substance – any substance within reason, that could be procured at a store or from a chemical supply company – and see how that affected the mutation rate. Each student (there were eight of us in the class) had to choose something different. I chose to work with caffeine, which is a suspected mutagen, based on some scientific literature that I found. So my hypothesis was that treating the bacteria with caffeine would increase the rate of mutation, and hence the rate of antibiotic resistance. I tested two concentrations of caffeine, 1 mg/mL and 3 mg/mL. What I found was very interesting – not only did the caffeine fail to increase the mutation rate, it actually (especially at the higher concentration) killed much of the E. coli! So I did some more literature research, and found that caffeine has been shown to also have an antimicrobial effect on E. coli. Who would’ve thought?!

I absolutely love science. You don’t always get what you expect, in terms of results (I certainly didn’t), but you usually learn something. And that’s the point: discovery.

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January 23, 2012

Building A Scientific Cathedral

cathedralA woman came across three men working at a construction site. She asked the first man what he was doing. He replied, “I’m making bricks.” She then asked the second man the same question. His reply was, “I’m making a wall.” When she came to the third man and repeated her question, he said, “I’m building a cathedral.”

Clearly, all three of these men were doing the same thing. But they had different attitudes, different visions, and a different sense of pride, about their work.

stone wallSo why am I telling this story? I think that there is a parallel to basic science work here (and I’m not talking about the chemical reactions involved in solidifying bricks and mortar). Like bricklaying, basic science involves a great deal of “manual” labor, which is sometimes repetitive and tedious. If that’s all you see about science, though, you’re not going to be very satisfied doing it – much like that first bricklayer. If you can make some connections, put the work in context, see it as the second bricklayer did – that you’re creating a wall – then it will be somewhat more fulfilling. But if you can continue to do your work while maintaining the sense that you are a part of something greater, that every discovery is built upon the work of so many other people, that you are constructing a “cathedral” of sorts along with other scientists, then the discipline becomes so much more.

I’m not going to lie. That repetitive work? I know that in my future as a physician-scientist, I may not always feel like doing it, or find it “fun.” But there will be a point to it, a greater goal, both within the context of my own particular research and within the larger context of science. And I find that thrilling.

Like the greatest cathedrals, our body of scientific knowledge has been built brick-by-brick. I look forward to laying a few of my own someday.

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January 21, 2012

Lovely Larvae

On Thursday, I started my work in the Genetics research lab. Granted, this may not be everyone’s cup of tea, but given that I want to do an MD/PhD, this is the perfect way for me to spend six hours each week (10 a.m. to 4 p.m. every Thursday).

Before beginning any actual “research,” my professor had me read two of his own published articles as background information. Both had been published in the journal Cell, which, if you’re not familiar with it, is quite prestigious. So his work has gotten some attention from the scientific community. He and his colleagues have been looking at olfaction (sense of smell) in drosophila larvaeDrosophila melanogaster larvae. In the first paper, they identified a set of genes responsible for olfaction in the larvae (previously, it had not been known which genes controlled the sense of smell in the larvae). This was really quite an accomplishment, and the methods they used were pretty amazing. (Don’t worry, I won’t go into the details unless someone asks!) In the second paper, they looked at behavior of the larvae in response to different organic compounds, both attraction and repulsion. I will be doing an extension of the second work, performing behavioral assays with the larvae and testing their chemotaxis response (that is, movement in response to chemicals). By the end of the semester, I will (hopefully!) have generated quite a bit of data, and will write a formal lab report about my progress.

In addition to doing the behavioral assays, I will also continue to read scientific articles, which will be great – I love getting exposure to more scientists’ work, techniques, etc. And there will be some freedom in the work I do as well – if I want to take the work in a particular direction not previously explored, I have the ability to do that, under my professor’s direction. Which is pretty amazing.

All in all, I look forward to this semester’s work. Who knows what we may find? That is the beauty of science.