Gaviola, Chelsea Aika
Arts and Sciences
Peru - Pulmonary and functional status of patients with pulmonary Mycobacterium tuberculosis post-treatment in Lima, Peru.
Tuberculosis is second only to HIV/AIDS as the greatest worldwide killer due to a single infectious organism. According to the WHO in 2010, an estimated 8.8 million people contracted tuberculosis worldwide and 1.4 million of these individuals died. The majority of tuberculosis deaths (>95%) continue to occur in developing countries. Impairment in lung function following completion of treatment for pulmonary tuberculosis has been an under-recognized cause of chronic lung disease worldwide. However, few studies have extensively characterized and compared residual sequelae of both drug susceptible pulmonary tuberculosis and multi-drug resistant pulmonary tuberculosis in patients following completion of treatment utilizing a large study population over prolonged periods of time (>5 years). Higher rates of impaired pulmonary function, pulmonary structural damage, residual lesions, persistence of respiratory symptoms, chronic disability and impaired functional status though strongly suspected to be greater in multidrug resistant tuberculosis compared to drug susceptible tuberculosis patients but have not yet been demonstrated in a large study. The evaluation of lung sequelae among pulmonary tuberculosis patients in Peru would build on existing knowledge of pulmonary impairment and reduced functional status among tuberculosis patients. Additionally, this information could be applied to tuberculosis populations globally. The main aims of this study are: 1) To determine if pulmonary impairment and reduced functional status (functional capacity and quality of life) is greater among participants with pulmonary tuberculosis post treatment compared to participants without a history of tuberculosis, and 2)To determine if pulmonary impairment and reduced functional status (functional capacity and quality of life) is greater among participants with multidrug resistant pulmonary tuberculosis compared to participants with drug susceptible pulmonary tuberculosis post treatment.
I did not know what to expect of Lima, Peru, or the idea of working there for two months to set up a longitudinal cohort study focused on tuberculosis. I had lived outside of the United States twice before—having been born and raised in the Philippines for six short months, and volunteered for a weeklong medical mission trip to Panama. Beyond those two experiences, I was an international traveling novice. On the flight from Baltimore to Lima, excitement and worry dominated. I questioned my competency in Spanish and epidemiology. I wondered whether I would be able to navigate around in a foreign language when I could not even navigate well in Baltimore. I worried how both the research team and the community that my project worked in would receive me. But I kept repeating to myself on the flight that, yes, I really was going to Peru to do public health research, and I should focus on how lucky and unique having this experience as an undergraduate is, and use it as motivation to learn as much as possible over the course of two months.
My research experience was challenging, but was one of my most rewarding as an undergraduate at Johns Hopkins. The opportunity involved initiating a large, population-based longitudinal study that focused on determining the pulmonary and functional status of pulmonary tuberculosis patients post-treatment. The project was in its very initial stages when I joined, and I conducted necessary logistic work to help get the project started. It was the first opportunity I had to work on project design at its beginning stages. I ensured that the protocol and consents were approved by the appropriate IRBs and all departmental jurisdictions where the research was going to take place. I attended meetings with various research coordinators and hired a field worker who was familiar with the community and could conduct the multiple surveys and respiratory tests required. I spent the majority of my time working on compiling databases to determine a pool of eligible participants to locate and enroll. During my last week in Peru, I had the opportunity to go into the peri-urban community of Pampas de San Juan de Miraflores and begin enrolling study participants. After completing weeks of logistical preparative work, it was extremely rewarding to see that the participant selecting had worked.
It was incredible to have this research opportunity after taking my Fundaments of Epidemiology course in the spring. The experience really put things into perspective about how one takes those academic concepts and applies them realistically, and especially how much flexibility and creativity is needed to apply them in a resource-limited setting. I also learned the importance of having an established team to conduct epidemiological research, especially fieldwork. PRISMA, my partner non-governmental organization, has been working with the communities of Pampas de San Juan de Miraflores and many others for the past 27 years, and it reflects in how knowledgeable they were of the community and how well-respected they are by the community. During the enrollment process, many times people who were on the fence about whether to participate in the study were convinced after being told we were from PRISMA. I was incredibly lucky to have worked with this team, who were so knowledgeable and patient with me whenever I had questions about crunching data in Excel or had difficulty framing certain sentences in Spanish. This language barrier was one of my biggest challenges, but now I can confidently say that my speaking skills are at a conversational level.
Prior to this summer, I was unsure of whether I wanted to pursue a career in international health, but this work clearly solidified my interest in the field. The disparity in health and wealth in the United States is nothing to trivialize, but the disparity seen Lima was to such a high degree that it strongly demonstrated the great need for global public health work. I was incredibly lucky to have been a part of this GHEFP program, and I would strongly recommend it to anyone who wants a hands-on, public health research experience.