MDR-TB (practice placement)
Mycobacterium tuberculosis (TB) remains the leading cause of death among persons living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) in southern Africa1. Drug-resistant TB remains a growing threat to public health despite advances in treatment and diagnosis over the past decade2;3. South Africa has the world’s highest rate of TB/HIV co-infection and ranks fourth worldwide for both multi-drug resistant (MDR) TB incidence and HIV prevalence.
This is the largest public health intervention on MDR-TB to date in South Africa with support from the Global Fund and The Centers for Disease Control and Prevention.
After 22 hours and multiple planes, I touched down in Durban, South Africa. Initially, I was strictly concerned with settling into the B&B for the night and establishing communication back to the states. After the first night went exceptionally smooth, we packed up and drove to our first site, Manguzi, a rural village on the Northeastern coast. Along the way, we saw various roaming animals including monkeys, squirrels and a plethora of cattle, chicken, and goats.
Once in Manguzi, we began working at the local tuberculosis clinic. Our work entailed gathering critical information on patient symptoms and treatments for multi-drug resistant tuberculosis and HIV. Prior to arrival, I was expecting to be working directly with patients; however, most of the research was centered on retrieval of data from patient files. Although the work I was undertaking was not what was originally anticipated, I was able to learn significantly more about global health and the process of conducting research in another country. For future students participating in the GHEFP program, I recommend entering the host country and research experience with an open-mind and flexibility. Research, particularly in developing nations, is a fluid process that is constantly evolving and changing. There are many challenges that arose with the original research plan that needed to be addressed and considered in order to move on with the project. Traveling to conduct field research, allowed me to take the skills and techniques I learned in my public health classes and apply them to real world challenges. However, writing a grant proposal and standard operating procedures manual detailing out the research goals and methods can be significantly different than actually implementing the study. For instance, while the data was supposed to be collected over the course of two years and involve hundreds of participants, in reality there were many obstacles that arose in setting up sites and recruiting a high number of patients into the study. Not only was participant retention a concern due to the long duration of the study, but also the proper employment and training of research assistants. For this reason, it is necessary to consider the health system of the host country and the methods used to higher and train health professionals.
While learning about the process of conducting research in South Africa, I was exposed to the Zulu culture. As this was my first time travelling outside of the US, I was open and eager to experiencing and learning the customs of the Zulu people. At first the collectivist nature, including the prioritization of family and leisure time with friends, was noticeably different. The research manager from South Africa, that we spent most of our time with, welcomed us into his home on multiple occasions. Some of the best memories of my journey are spending time with him and his family.
MDR-TB research team on the last day together in Durban, South Africa;
Waiting room at the King Dinizulu Hospital. The sign is written in English and Zulu;
Male in-patient ward in the tuberculosis wing of the hospital. Only those with XDR-TB and severe MDR-TB were kept as inpatients in this location;
Posters throughout the hospital detailing the precautionary procedures to take with TB;