Walker, Shannon

School of Medicine

Resident

Uganda

I will join a project focused on improving linkage to care for patients diagnosed with Tuberculosis (TB) in Kampala, Uganda. To increased the number of diagnoses of TB, we will continue to train Mid-Level Providers to identify and manage patients with TB, as well as expand the use of Fluorescence microscopy and Xpert MTB/RIF diagnostics to rural healthcare facilities. Then we will implement and evaluate a simple low cost mHealth intervention using text messaging to improve linkage to treatment for patients diagnosed with TB. Patients who are diagnosed with TB at selected hospitals will receive text messages on Day 1, Day 3, and Day 7 notifying them of the diagnosis and asking them to return to the hospital to be initiated on TB treatment. We will compare the number of patients diagnosed and started on treatment to control facilities without these interventions. 

During this project, I will have the opportunity to work with very experienced global health researchers both from Uganda and the US. I will receive direct mentoring in addition to research training. I will gain experience in engaging with a community, training local people as health care workers to build capacity, and implementing a new diagnostic algorthim to improve disease treatment. As this is my first global health research opportunity, this will provide me with a solid foundation of skills that will be directly translatable to future global health care endeavors. 

In my 8 weeks in Uganda, I worked at the Infectious Disease Institute, a research institution that is associated with Mulago Hospital, the largest public hospital, and Makerere University, a very prominent university. I joined the H2U research team that studies HIV, Hepatitis and other risk factors leading to Hepatocellular Carcinoma in Uganda. Hepatocellular carcinoma (HCC) is a highly morbid cancer that affects the liver. The incidence of HCC is high in sub-Saharan Africa, and many patients present with widespread disease and die within the first 6 months of diagnosis. The H2U team I joined is conducting two five-year studies to further investigate the causes of HCC, and to find ways to prevent the deadly disease.

Within the research team, I fulfilled the role of data quality assurance and quality control (QA/QC). On a day-to-day level, I would review the forms with each patient’s information to make sure they were complete, and then fax the forms into the DataFax system so that the team could convert paper records into the electronic system. From there, the statistician was able to manipulate the data. I found that within the process of collecting primary data and eventually transferring to the statistician, a few problems arose along the way. Oftentimes there was missing data or lab results, or some of the answers were incongruent. It became my job to respond to the data queries, which were reports that returned detailing problems with incorrect or missing data. With the other doctors, I would correct and return the problematic data points. During the time I was with H2U, they were without a primary point person to help with data QA/QC, and so I filled a very helpful niche for the team. In fact, after I left, they hired another research physician and nurse to bridge the gap and take over some of the tasks I had performed.   

The most meaningful part of my research experience was working with the team of physicians, research nurses, and technicians. They were incredibly dedicated to their tasks, and often had to overcome obstacles that many research projects in the US do not typically face. For example, there were times when certain technologies (such as building electricity or the DataFax machine) were not working. This often slowed the pace of work, or even required certain tasks to be repeated. However, the team worked tirelessly and positively to keep a rapid pace of recruiting new patients and importing the data. I found that each team member, regardless of position, would willingly assist with any needed task. I learned not only from this work ethic, but also from the way they each interacted with one another. There were weekly team meetings wherein results of the project were discussed, and anyone could voice concerns about the project. There was a lot of respect between different team members regardless of role or level of training, and everyone’s voice was heard. Furthermore, there was a culture of caring in which people knew each other’s families and personal lives. This exposed me to an inner team dynamic different from teams I had experienced in the US.

I am very grateful to the Lietman Fellowship and the School of Public Health for this opportunity. I gained experience in global health research, specifically in the areas of QA/QC, and I also learned how to critically reflect on the processes of study design, and think of creative ways to fill gaps and troubleshoot problems. Furthermore, I learned interpersonal, team-building, and communication skills from my co-workers. Now that I have returned to my Internal Residency program at Johns Hopkins, I have already started applying some of these interpersonal lessons and themes to how I practice medicine, such as: ensuring everyone’s voice on the care team is heard, remembering that no task is beneath me, and that obstacles are to be overcome with positivity and creativity. These themes will continue to affect the way I practice medicine, work with teams, and conduct research in the future.

People

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Caitlin Kennedy, PhD MPH,BA

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

Robert Bollinger Jr., MD MPH

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

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program
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December 2019

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