Klapheke, Robert

School of Medicine

Residency

Peru

This experience would represent my first opportunity as a medical doctor and co-investigator in a global health setting. I will be interacting with subjects and research staff directly as a part of a study based in Iquitos, Peru. I will be collecting buccal saliva samples and anthropomorphic data to assess the association of FUT2 (an enzyme that helps secrete ABO antigens on the gut-lining of some but not all humans) with disease with particular enteropathogens (Norovirus, E. coli, Campylobacter). It will take place at subjects' homes as well as the JHSPH clinic in Iquitos. The majority of encounters will take place in Spanish. This experience will afford me the opportunity to participate in direct data acquisition, electronic data analysis, and research planning. I will also be invited to actively observe clinical rounds in gastroenterology and infectious disease at a local hospital. I plan on keeping a journal to document and share my experiences. Overall, this project will allow me to showcase and build my ability to research and engage clinically in an international (particularly Spanish-speaking) environment.

Collaborating Institutions: Asociacion Beneficia PRISMA

            “Hello, my fren’!” I heard it over and over again walking around town or in the hospital. I initially took it as someone trying to sell me something, but eventually it became clear that people sometimes just want to acknowledge an outsider in a friendly, welcoming way. I had been to Iquitos, Peru twice before but exclusively as a tourist and for only brief periods of time. I returned with the intention to do research and clinical work, and I left with a reinvigorated sense of community and perspective. 

            Through Dr. Margaret Kosek at Johns Hopkins School of Public Health, I discovered a project she was developing about an enzyme called FUT2 and how its actions are potentially linked to what diarrheal microbes people become infected with and the severity of those infections. Thus I got to meet the on-site Peruvian staff of the JHSPH Iquitos Satellite Lab, a group of outgoing, warm and intelligent scientists and ancillary staff. Ángel, a self-described “do-anything-guy”, picked me up from the airport in his moto-taxi (essentially a motorcycle attached to a passenger cart; an absolute must for the Iquitos citizen on the go). Even in my travel-induced haze I could tell he was a genuine guy. He was born and raised in Iquitos, with a difficult to understand Spanish dialect but no shortage of patience to repeat himself when asked. Ángel and many of the other staff had additional nationalistic incentive to learn more about the infectious diseases that plague Peru, and they were eager to help me do the same. Walking around Santa Clara, one of the nearby villages included in the study, the sense of unity continued to resonate. People greeted my guides by name. They asked me mine. They waved, welcomed and thanked me for taking an interest in their community. There I was, an out-of-place gringo doctor, simultaneously made to feel right at home.

            At the Hospital Regional de Loreto, I began to worry this closeness could threaten my negative TB skin test status (ha ha). Working with the infectious disease team on the medical floor and in the emergency department, I was fortunate to see a great variety of cases. Malaria, dengue, tuberculosis and leptospirosis found their way onto more differential diagnoses than I had ever formulated in Baltimore. Zika virus became less of a newspaper headline and more of an immediate clinical consideration in the patient in front of us. A particularly memorable case included a 36 year old woman with a history of “too many to count” episodes of malaria who presented with fever, abdominal pain, nausea and vomiting. She was also 13 weeks pregnant and spoke a dialect exclusive to a remote area on the border of Peru and Brazil. Her husband served as translator. Ironically I found myself, a foreigner, interviewing an apparent foreigner in her own country. She was eventually diagnosed with malaria and leptospirosis. Treatment included IV quinidine, a medication better known to me as a relatively antiquated antiarrhythmic drug. The residents, unfazed, wrote the order into the paper chart as the attending dictated it theatrically for the team. She made a full recovery with her pregnancy intact. I walked away with a wealth of new knowledge about tropical infectious diseases from the residents, faculty and patients. My TB skin test even remained negative. 

            I ultimately left Peru with a suitcase full of paintings, soccer jerseys, wooden sculptures, and jewelry. Much more important were the experiences, too many to fit in my carry-on. Outside of scientific and clinical contexts, I hugged sloths named Pablo and Marguerite; I saw a pink dolphin showing off with a leap in the Amazon; I met the soon-to-be First Lady days before witnessing the closest presidential election in Peruvian history; I joined an open-air gym and struggled to lift weights in 80% humidity; I hand-fed manatees at a refuge; I cheered in a crowded pub as we watched Peru and Ecuador face off in the Copa America; I danced like an idiot at an outdoor reggaeton concert; and, of course, I made friends from Peru and all over the world I’ll never forget. I returned home, but I continue to carry all of this with me, with the inspiration to spread that same sense of community and open perspective to others. At the airport on my last day, I hugged my friend Marcel, and before he could beat me to it, gave a heartfelt, “Goodbye, my fren’!” “No,” he replied, “until next time, my fren’!”

People

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...
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August 2019

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