School of Medicine
My fellowship research will focus on antimicrobial resistance in Uganda and building surveillance systems for monitoring resistance. I plan on spending a significant portion of my second year of fellowship in Uganda to establish this research project and in collecting data. I plan to travel back and forth to the U.S. approximately 4 times to attend planned conferences and meetings, i.e. IDSA in October 2016. I will be working with Dr. Yuka Manabe and with Dr. Sara Cosgrove as my mentors to characterize antimicrobial resistance in several collaborating health care settings in Uganda and to use the data to create an antibiogram(s) with the goal of using this data to generate stewardship efforts. There is very minimal data on antimicrobial resistance on the continent and I am currently working on a systematic review of antimicrobial resistance in sub-Saharan Africa (excluding S.Africa) to lay the groundwork for this project. This research project is directly applicable to my training goals and future career plans. I plan to complete this project in the next two years and to continue building on this work throughout my early career and beyond.
Infectious Diseases Institute, Makerere University, Uganda
I spent August 2016- June 2017 based in Kampala, Uganda. Although I was born in East Africa (Ethiopia), this was the longest I have lived outside the United States since I moved here 16 years ago. This was a time of immense personal and professional development for me. Professionally my time in Uganda was highly productive. My research was focused on antimicrobial resistance (AMR) broadly in resource-limited settings, as well as improving diagnostic capability as it relates to antimicrobial resistance in these settings and designing antimicrobial stewardship systems. I spent my time in Uganda embedded as a fellow with the Global Health Security Engagement Project: a Centers for Disease Control (CDC)-sponsored project designing and implementing the first national antimicrobial resistance surveillance program, building microbiology capacity and developing a national antimicrobial stewardship training and implementation program. During this time I helped lead projects that were already underway, as well as developed my own research projects and QI initiatives, some of which are highlighted below:
- Implementation of a national gonorrhea surveillance program currently being piloted at 5 sentinel surveillance sites in Kampala. During my time here we were able to scale up from 3 sites to 5 sites and increased sample referral from 5 samples in October 2016 to 20 in February 2017 and over 70 in March 2017 with 70% of samples being positive for Neisseria gonorrhea.
- Designed workshops on sterile blood culture collection technique to decrease contamination rates in AMR blood culture surveillance data.
- Proposed and designed “procedure corners” in the emergency department and two pediatric wards as a pilot to decrease contamination rates and to augment infection control efforts.
- Created and implemented a data QC protocol for blood culture AMR data to improve the quality of data being collected and entered from remote sites due to high rates of errors, inconsistencies, omissions and duplicates in data.
- Designing an antimicrobial stewardship curriculum for government regional referral hospitals in Uganda.
Uganda is an extraordinarily beautiful country, with a hospitable and welcoming culture. I found it easy to integrate socially and Kampala is a cosmopolitan city with a very international feel to it in some ways, while retaining a very East African bustling, vibe, with crowded marketplaces, streets, motorcycle taxis, fruit and street food stands everywhere you look.
Professionally, my largest lesson in working in international settings is to spend a significant amount of time investing in the people and environment you work in. It is important to build and gain trust versus diving in and trying to “change” things. I had the luxury of an extended time in-country and was really able to build relationships and understand systems prior to trying to build new systems and create and implement programs. This benefited me hugely. I was able to collaborate across a number of different organizations including the Infectious Diseases Institute, CDC, Makerere University Department of Medical Microbiology, Infectious Diseases Research Collaboration, etc.