Thursday, April 27, 2017

The Cervical Length Study in Botswana

Ingrid Liff
Maternal Fetal Medicine Fellow at MGH
PGY7

The Cervical Length Study in Botswana: Entry 1

It is a quiet Easter weekend here in Botswana. (The country goes on holiday for the Friday before and the Monday after Easter.) I am using this time to finalize another grant application, and watch some statistics classes through the Harvard Catalyst.

This is a research block for me. I am in Botswana to complete recruitment for the Cervical Length Study, which I started at the beginning of my fellowship to understand whether preterm birth in HIV-infected women is mediated by the cervix. I am working with a great mentor in my department, and great Infectious Disease mentors at the Botswana Harvard Partnership. Each day I drive an hour out to Scottish Livingstone Hospital (SLH), a large district hospital in Molepolole, Botswana where I recruit patients. I spend the days performing ultrasounds in the X-Ray Department. My friend Mr. Mingochi, an ultrasonographer at SLH, is a big supporter of the Cervical Length Study. He always gives me a key to the office and a key to the small room where I perform scans for the hospital and for my study. These keys are a symbol of friendship and of the success of the study so far.
Ingrid and Mr. Mingochi in the ultrasound unit at Scottish Livingstone Hospital in Molepolole, Botswana
I do obstetric scans while I am here, taking part of the work-load off of Mr. Mingochi. I spent most of my first month in Botswana trying to understand how SLH schedules women for ultrasounds during pregnancy. An ultrasound during pregnancy is recommended by the Ministry of Health in Botswana, but often not performed due to limited human resources for ultrasound. (The first months I was in Molepolole recruiting for the study, Mr. Mingochi was the only sonographer in the hospital – responsible for inpatient and outpatient scans for brain, abdomen, breast, thyroid, and other pathology, not to mention routine obstetric scans.) After months of outreach and working with the scheduler at the front desk of the X-Ray Department, some women present for a scan prior to 32 weeks gestation during my recruiting pushes.

For the Cervical Length Study, I recruit volunteers between 22 weeks and 24 weeks and 6 days of gestation. If a woman chooses to be in the study, she signs a consent, fills out a brief questionnaire, and we measure her cervix by transvaginal ultrasound. A research assistant, the lovely Findo, helps me explain the study, consent patients, and complete the questionnaires.

This is my last recruiting push for the Cervical Length Study. So far, things are going well. We have recruited almost 20 patients. We also did outreach to the surrounding clinics this past week to say thank you to the midwives who send patients for ultrasound while I am here. We always bring small gifts of Harvard pens or chocolates, another key to the success of the study thus far.

“The Length of the Cervix Among HIV-infected Women at Scottish Livingstone Hospital in Botswana” is also supported by the Queenan Fellowships for Global Health – Investigator-Initiated Research, The Pregnancy Foundation.

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