First Patient Enrolled - Nate Herr (PL2)

Posted on behalf of Nate Herr (PL2)

With nearly perfect triumphal timing, it's my final week here and we just enrolled the first patient.  The process went smoothly, and in observing it all, it felt good see the family acting quite content and pleased to be receiving quality care and attention to detail both now and over the next year. 

They weren't the only ones pleased.  Many members of the NDI study team stopped by to say hello; from the lab technicians to the home visit coordinators.  The first enrollment is always a big day!

GHU NDI Project Director, Ruth Namazzi, and Medical Officer, Denis, go over the enrollment forms in the consultation room.  (patient and family not photographed)

Also, I must note that Ruth is an excellent Ugandan pediatrician and is the Project Director here for the NDI study.  If you're in Minnesota this month you'll have the chance to meet her on April 29th when she presents her results on "Change in Hemoglobin concentration of Children with Severe Anemia at Mulago Hospital: A Prospective study."  It's her first time visiting Minnesota and the presentation will be at Dr Cindy's house at 6:30pm.

GHU Study Group Photo from Nate Herr (PL2)

Posted on behalf of Nate Herr PL2

Fantastic group shot of the GHU study group retreat Nate recently posted about on the blog!

Nate Herr (PL2) on Getting an R01 Study Launched

Posted on behalf of Nate Herr (PL2)

After the safari, I returned to my routine of rounding in the PICU and stabilization room 2-days a week.  The remaining days of the week were dedicated to the various and many research study tasks surrounding getting a new R01 study launched.  This study will follow a spectrum of children admitted with severe malaria-- taking detail to discover more about the causes and outcomes of the different types; Coma, Seizures, Anemia, Acidosis, and Prostration.

Chandy John, Director of the Division of Global Pediatrics at UMN, had arrived in Uganda while I was out on safari.  In the next 3 weeks that he was here he facilitated meeting after meeting on his multiple clinical studies here-- including the NDI study I've been working on and described briefly above.

To answer a question, you need data.  And to get data you need forms.  The forms for our study collect somewhere around 7,000 variables per patient.  With our goal to take in all comers with severe malaria, we are expecting a lot of variables and a short and fast enrollment period-- both of which called for efficiency in the data collection and verification process.

Karen Hamre, MPH, a PhD candidate at the UMN and current Fogarty Fellow, arrived 2 weeks ago and brought her skilled eye for detail and perspective of data analysis to the group.  It took almost a weeks worth of revisions and multiple rounds of feedback from everyone.  We spoke with everyone from the bedside nurses to the principle investigators to create a set of forms that we believe will efficiently and accurately collect the information we'll need. While it brought on headaches, it was great to have the many perspectives involved early on before the actual roll our of the study.

At the end of Chandy's time here, we weren't yet ready to enroll any patients, but we had made much progress in ensuring that the process would be smoother when it happens.  That last weekend he was here, the Global Health Uganda staff from across the country met for their annual retreat, and ventured out to an island in Lake Victoria.

For most it was their first time at the island, and for many it was their first time on a boat.  With the entire GHU staff at the island you soon saw how they were a big family, enjoying the company and friendships build over time as the NGO approaches 15 years.  It's been a great privilege to work with them as it's apparent to all that they strive for excellence in whatever their task or role.

The retreat did it's job in bringing rest and relaxation, something we needed with the multiple studies set to launch this spring.

Nate Herr's (PL2) Safari Story in Pictures

Posted on behalf of Nate Herr (PL2)

Hello again from Uganda!  I realize now that it's been a month since last checking in with our blog-- sorry about that!  I've been quite busy with a few things.  Chandy John has been on site and we've had productive meetings, and have been working on editing of forms to make our data collection more efficient.  Look for an upcoming post with more details.  

Since arriving back in mid-February for my 2 month rotation there was time to fit in a visually breathtaking safari.  

I took some of my PTO in early March when Abby came to visit for a week. While we did spend a couple days around Kampala and at the Mulago Hospital, we first went up north on a 3-day safari.  Our main stops along the way were the Ziwa Rhino Sanctuary, where they're reintroducing them back into their natural habitat after being poached to elimination years ago, the big Murchison Falls Game Park, and the Budongo Forest for chimp tracking.  

Pictures say it all, so here they are! 

Sunrise

Rhinos resting in Ziwa Rhino Sanctuary

A view of the Murchison Falls Game Park

Antelope at the Murchison Falls Game Park

An elephant at the Murchison Falls Game Park

Giraffes at the Murchison Falls Game Park

A hippo at the Murchison Falls Game Park

Warthogs at the Murchison Falls Game Park

Cranes at the Murchison Falls Game Park

A crocodile at the Murchison Falls Game Park

A mahogany tree

A chimpanzee at the Budongo Forest

Hope you enjoyed the photos!

-Nate

Neuro-developmental Impairment in Malaria - post from Nate Herr (PL2)

Posted on behalf of Nate Herr (PL2)

I've alluded to some of the pediatric clinical research and
collaboration happening here in Kampala, it's really quite extensive and
thorough.  I'll do my best to summarize.

Malaria has long been a common disease in the equatorial tropics.
 It has a spectrum of severity, depending on the type of malaria one is
infected with and the age and health of the person infected.  The most
severe form of malaria is cerebral malaria which involves a patient in
coma and is fatal if the malaria is not treated.  This is thought to be
from the parasitized red blood cells sequestering in the blood flow to
the brain or due to inflammation, the answer is not yet clear.

Earlier, the same collaboration group with UMN and Mulago Hospital,
studied and compared two types of severe malaria.  One that I
mentioned, Cerebral Malaria, and Severe Malaria with Anemia.  They
followed the children through their illness and after they went home.
 They did continued EEGs tracking seizures, neuropsych and cognition
testing and found that children with anemia and no initial brain
involvement with their malaria still had deficits and disability down
the road.  These disabilities are a big problem in Uganda and
sub-saharan Africa and already the research group here is studying to
see if rehab programs can help children regain their abilities.

What is about to start is a broader look at children with milder
forms of malaria to see if they also have disability from it.  In this
study, blood tests will also be done to look for clues as to what is
actually causing it.  Home visits and clinic visits will again follow
the children after their initial illness.

Ahmed, Denis (our two medical officers with the study) and Dr. Postels

Our Ugandan Medical Officers are a critical part of this.  We held a training session today with Dr Doug Postels,
our Michigan State collaborator.  He lectured on the neuro exam then
afterwards the medical officers practiced, asked questions, and gave
much needed feedback on the forms and documentation that we've been
editing and creating these last weeks.

Every day I'm learning another piece of what it takes to get good
information to answer good questions for the betterment child health
care.  Nothing is ever simple and straightforward and the best insight
comes from looking at the problem from all angles-- with medicine being
only one of the angles.

[one hundred and] eighty degrees difference - Nate Herr (PL2 arrives in Kampala)

Posted on behalf of Nate Herr (PL2)

Leaving Minneapolis, I left behind a consistently cold winter. averaging temperatures in the single digits.  A day's worth of flying later, and a much more ambient temperature, greeted me in Kampala.  As it's in the 70s and 80s here. Gone are the snow banks and drifting snow, replaced by red dirt and dust that coats most everything and keeps a layer of haze across the skyline.

Warm temperatures and dusty red roads weren't the only thing to greet me.  What I found in Kampala was group of collaborators from Uganda and the University of Minnesota who are working here to answer the unanswered questions of some of the most aggressive and common infectious diseases here; from cryptococcal meningitis to severe malaria. Some have been here for months, others a few years or their entire life.  As the newcomer to the team, here only for a week now, I look forward to taking it all in and helping where I can.