Wednesday, September 16, 2015

The "black box" of pulmonary epidemiology in Uganda part 1

January 25, 2015

Crystal North, MD
Clinical Research Fellow
Division of Pulmonary and Critical Care Medicine
Massachusetts General Hospital

Stepping out of the airport in Entebbe and breathing in that first lungful of Ugandan fresh air never ceases to rejuvenate my jetlagged mind. My first trip here, I wasn’t sure quite what to expect. I had worked in other African countries, but it was my first time to Uganda.  18 months later, I’m returning with a specific purpose, and I can’t wait to get started.

Allow me to back up a few steps.  I’m a Pulmonary and Critical Care fellow from Massachusetts General Hospital, drawn to the study of lung health in sub-Saharan Africa because of the large “black box” that is pulmonary epidemiology in the developing world.  As a scientific community we’ve discovered that respiratory disease is the third leading cause of death and disability globally, and we know that air pollution from a lack of industrial regulations and biomass fuels is the leading threat to lung health internationally. What we don’t yet have a grasp on is what the epidemiology of lung disease in the developing world looks like – who gets lung disease, when do they get it, what other diseases might they have, how bad does the lung disease get, and do they die earlier than those who don’t have lung disease?  Since most developing countries lack enough (if any) pulmonologists or machines for pulmonary function testing, the opportunity to have a lasting impact on understanding lung health is significant.

I’ve come to Mbarara to begin work on two specific projects that will begin to shed light on some of these questions.  Each focuses on the epidemiology of pulmonary function in southwestern Uganda, and each has a slightly different approach.  First, in collaboration with an Infectious Diseases colleague from MGH, we will be studying the epidemiology of chronic lung disease in people living with chronic HIV in southwestern Uganda.  Chronic HIV infection is a risk factor for chronic lung disease in US and European cohorts, but whether this also holds true for those living in sub-Saharan African is unknown.  This study is set to begin enrollment in July 2015, so the primary purpose of this trip to Uganda is to finalize and submit all IRB documents to the Ugandan IRB and to deliver all equipment and supplies necessary to perform pulmonary function testing (two suitcases worth!).
I’m extremely lucky to be working with an established research team that has been enrolling study participants together for the last year, and am looking forward to meeting them this week and working together over the next 2 months and beyond.  My previous trip to Uganda was not research-focused, so I am eager to begin learning about the research infrastructure at the Mbarara University of Science and Technology (MUST), the processes for IRB submission and review, and generally how to go about beginning a study in another country.  I am fortunate to have excellent leadership in the junior and senior faculty who have gone before me, and I’m excited to begin this new chapter in my professional life.

Off to a little sleep (jetlag-willing) before the 5 hour drive to Mbarara in the morning!

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