Tuesday, April 10, 2018
Resident in Medicine/Pediatrics at MGHPGY-3
Pediatric tuberculosis, a multinational approach
I’m working on with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) on a multi-national pediatric tuberculosis project. Pediatric TB is notorious difficult to diagnose because kids tend to have a hard time coughing up a sample to test, and the samples tend to have a lower concentration of TB so our tests are not as sensitive as they are for adults. One area on which the project focuses is increasing the availability of new child-friendly, fixed-dose formulations of TB medications. These formulations are easy to take because they dissolve in water and they reduce the number of pills kids have to take each day, improving adherence and treatment success. EGPAF is also looking at ways to improve linkage to/retention in care; not only does this improve patient outcomes but it also increase the demand for these new pediatric TB medicines, thereby stabilizing the market and making it worthwhile for more generic drug manufacturers to make these medicines, which then in turn drives down their cost.
The proposed project spans four years and ten countries across sub-Saharan Africa and India. One of my motivations for doing this rotation with EGPAF is to see how an organization coordinates this kind of multinational project, as well as see in action the type of advocacy work organizations are able to do when they are situated in Geneva in terms of influencing new guidelines that are released. I had the opportunity to assist with an analysis of the political and current clinic guidelines for pediatric tuberculosis in each country. This gave me the opportunity not only to learn about the clinical standard of care in contact tracing, diagnosis and treatment of TB in children, but also gain more insight into the nuances in policy that shifted from country to country. After analyzing multiple national strategic plans and national guidelines, it becomes easier to differentiate the countries that have the political will and funding to try to translate strategic goals into concrete action items and guideline changes.
Being able to discuss these nuances in public health policy with experts in the field of pediatric TB and watch them influence the conversations happening on the ground through our country teams who interact regularly with each National TB Program was also very interesting. The background of the members of EGPAF Geneva office range from infectious disease physicians to former Doctors Without Borders humanitarian aid workers to advocacy experts. I found surprising how few of the people who work at either the WHO setting these clinical guidelines or in these large international NGOs that help translate those guidelines into practice have ever treated a patient with that disease, but I love learning from the wealth of experience they do have in the field of public health or aid work.
Resident in Medicine/Pediatrics at MGHPGY-3
Global Health in…Switzerland?
For my away rotation this year, I am spending a month with the Elizabeth Glaser Pediatric AIDS Foundation in their offices in Geneva, Switzerland. While Switzerland is not the typical location for a global health away elective, as evidenced by the other posts on this blog, my hope was that working at the European headquarters of a large international NGO would complement the other experiences I’ve had working in field offices and government hospitals where many of these programs and their like are being implemented.
I recently heard a statistic that more than half of Geneva’s residents are not Swiss citizens. Certainly as I sit on the bus on my way to work as it winds and wends its way out of the city center to the northwest corner of the city where the UN, WHO, UNICEF, UNHCR and the ICRC (International Committee of the Red Cross), and a whole panoply of other acronymed NGOs, it is easy to believe that is true. In the EGPAF Geneva office alone, the nationalities represented include: Swiss, American, Canadian, Kenya, Italian and French, with the Switzerland the sole claimant of more than one citizen. The polyglot of languages represented on every sign and even automated bus announcements further emphasizes that Switzerland is a relative recent-comer on the European scene, cobbled together from territories that trace their routes to France and Germany respectively.
The other thing that jumps out at my during my first few days of getting used to the rhythm of life in the office is how essential the internet has become to the way EGPAF and organizations like it work. When I worked and lived in Sierra Leone 8 years ago for a similar large NGO, the internet was essential for contact with our headquarter offices, but given the poor quality and slow speeds of the connection, the country team was largely left autonomous, except during key times like the final stages of a report or grant submission. Now, the days are filled with emails and conference calls filtering in from multiple time zones across the world, starting in the early morning hours from the India team, then during the morning from offices in sub-Saharan Africa, stretching well into the evening with the Washington DC headquarters. (Interestingly, and inexplicably, our office phone acts like an US number.) Sure, the first 5-10 minutes of a large intercontinental conference call is still always filled with connectivity issues, but the ease with which questions and answers can fly across the world, allowing experts based in different countries and the implementers on the ground to troubleshoot and shape projects is still a thing of marvel. The careful balance between autonomy and supervision between the headquarters offices and the country offices is strongly reminiscent of the balance we try to strike in the hospital as residents while working with interns and attendings.