Krishnan, Sonya

School of Medicine - Internal Medicine

Peru

I will be traveling to Iquitos, Peru and collaborating with researchers at the Universidad Peruana Cayetano Heredia. My mentor is Dr. Robert Gilman, a man who has advocated for the implementation of sustainable research infrastructure in South America. He will be on site in Iquitos during my travel period and will help with my assimilation onto the team. I plan to assist with the improvement of a microscopic-observation drug-susceptibility assay in Tuberculosis-HIV co-infected individuals. This technique involves culturing patient sputum in broth impregnated with varying combinations of antituberculous drugs. The goal is to create a rapid, cheap, and sensitive tool to help detect multidrugresistant tuberculosis in sputum that will help to guide treatment and that will improve detection and will expedite care in resource limited settings. While my ultimate career interest lies in the health of immigrants in the United States, I have found through my field research in Tanzania and Kenya that experiences abroad in the health sphere are critical to my development as a culturally competent provider. Through being in the field in an international setting, I am able to also learn about Peruvian and South American culture, improve my Spanish language skills, and better understand Peruvian attitudes and beliefs towards illness. In bringing these experiences back to the US, I will be better equipped to meet the cultural, linguistic, and social needs of the patients who I strive to treat.

Universidad Peruana Cayetano Heredia

Iquitos, Peru

Walking into the courtyard at the Hospital de San Juan de Dios, I was unsure of what to expect. The 310 bed hospital serves as one of the major hospitals in Santa Cruz, Bolivia and the surrounding area. The idea of working in a hospital outside of the United States was not a new experience for me, as I had previously spent time in Kericho, Kenya and La Esperanza, Honduras. This, however, would be my first time as a physician.

I had come to Santa Cruz to assist with and help to develop a research study on Chagas cardiomyopathy. While Chagas is not a common term that we hear in the United States, it is actually the third most common parasitic disease in the world, after malaria and schistosomiasis. One of the feared complications of chronic infection is cardiomyopathy, which is associated with a 4% annual mortality in patients followed in the outpatient setting. Chronic Chagas has no cure.   

Within the Hospital de San Juan de Dios, I found a bustling and vibrant community of dedicated clinicians and care providers. The hospital provided many state of the art interventions that I associate with the standard of care in the United States. The hospital had Echography, MRI and CT scanners as well as a cardiac catheterization lab. My prior travels had been to smaller community hospitals within Kenya and Honduras, both of which would need to refer patients to larger tertiary care centers, should any intervention or advanced imaging be required. In regards to internal medicine, the hospital had two wards – a men’s and a women’s ward. These wards provided care for approximately 25 patients each, in one large room.

  

Left: Samples of vinchucas (Triatoma infestans). Used in clinic to help patients identify the insect in their homes that carry Chagas. Right: Study visit at the Chagas Cardiomyopathy Clinic.

The appearance of the research clinic itself, where we recruited and enrolled patients for our trial study Chagas Cardiomyopathy was similar to those that I had encountered in the United States. The greatest challenge to conducting medicine and research abroad, that greatly differed from my prior experiences, was due to the Bolivian culture of public protests and strikes. The president of Bolivia, Evo Morales, was attempting to introduce legislation that would make medical malpractice punishable by imprisonment. While in the US, physicians are unable to collectively strike, in Bolivia, the majority of outpatient physicians had stopped working. The research clinic elected to continue working and conducting the clinical trial.  Given the ongoing strikes, we would often be visited by internal medicine residents who would request the use of this machine for hospitalized patients – as the EKG center was often closed due to the strikes.  This could often lead to some difficult conversations, as we only had limited EKG electrodes. If we used all of the electodes on hospitalized patients, we would be unable to collect EKGs on visiting study participants – one of the most important data points of our clinical trial.

People

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Robert Bollinger Jr., MD MPH

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

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Caitlin Kennedy, PhD MPH,BA

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

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation
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