Apparently, my other life needs me too.
http://www.nytimes.com/2009/05/19/health/19well.html
Wednesday, December 9, 2009
Sunday, November 8, 2009
Lions with a touch of cynicism.
I, admittedly, do not blog. I know this disappoints some people. I am lazy. And busy. And I find myself tiresome when I do write. However, this week I am going for a photo story. Let us consider it a compromise.
In order to help remember that South Africa is not a just a place to go to have your research plan fall apart, lose touch with friends from home and get your passport stolen, I got out this weekend. We went to the Lion and Rhino Nature Reserve just outside Johannesburg. It was phenomenal.
1. "Dumb Human." This photo is blurry, but included here because this is the cheetah I raced. I actually won. This is because the cheetah was smart and stubborn as cats tend to be and simply chose not to chase the blue teddy bear which was being pulled on a string in 32 degree weather. I, on the other hand, apparently could wear a collar and be trained to sit. My defense: it WAS a really cute teddy bear.
2. "Don't f' with me. I have a snake." Evidence that having huge snake around your neck will always make you look badass and like you could kill someone. Even if you are making out with said snake. Seeing this photo makes me reconsider my lack of a skull tattoo on that right bicep.
3. "Gurltalk." This white lion is my new best friend. As you can see, she and I had a heart to heart and discussed a range of topics including the US joining SA in the ranks of leaders who've won the Peace Prize, Impala versus Kudoo meat, and men of all nations who aren't good enough for us anyway.
4."A good spoon." Is there anything more to say?
5. "Ouch. I have nerves there." This tiger was playful. And had huge claws. They felt un-good in my skin. But I couldn't resist.
6. "Adopting This One." In the end, I opted not to bring her home. She was 2 months old. Its only a matter of months before she would be able to give Socrates a run for his money. And I can't do that to Soc's ego.
I should add that I almost got eaten by a lion. Seriously. Ok. At least bitten. Other highlights included: Petting a rhino; Watching the cheetahs in the reserve get fed- man do they jump high; Falling down a hill; Teaching my Brazilians English words such as "Mane," "calling shotgun," and "charge"- as in "Keep driving. That rhino looks like he might 'charge' the car;" The hippo walk; Hearing wild dogs 'laugh'; Having a full grown male lion feet from my car; And drinking almost a liter of orange Fanta. The day was actually quite amazing. I needed it badly.
Getting mugged and attacked by a lion... in the span of one week... now THAT is South Africa.
In order to help remember that South Africa is not a just a place to go to have your research plan fall apart, lose touch with friends from home and get your passport stolen, I got out this weekend. We went to the Lion and Rhino Nature Reserve just outside Johannesburg. It was phenomenal.
1. "Dumb Human." This photo is blurry, but included here because this is the cheetah I raced. I actually won. This is because the cheetah was smart and stubborn as cats tend to be and simply chose not to chase the blue teddy bear which was being pulled on a string in 32 degree weather. I, on the other hand, apparently could wear a collar and be trained to sit. My defense: it WAS a really cute teddy bear.
2. "Don't f' with me. I have a snake." Evidence that having huge snake around your neck will always make you look badass and like you could kill someone. Even if you are making out with said snake. Seeing this photo makes me reconsider my lack of a skull tattoo on that right bicep.
3. "Gurltalk." This white lion is my new best friend. As you can see, she and I had a heart to heart and discussed a range of topics including the US joining SA in the ranks of leaders who've won the Peace Prize, Impala versus Kudoo meat, and men of all nations who aren't good enough for us anyway.
4."A good spoon." Is there anything more to say?
5. "Ouch. I have nerves there." This tiger was playful. And had huge claws. They felt un-good in my skin. But I couldn't resist.
6. "Adopting This One." In the end, I opted not to bring her home. She was 2 months old. Its only a matter of months before she would be able to give Socrates a run for his money. And I can't do that to Soc's ego.
I should add that I almost got eaten by a lion. Seriously. Ok. At least bitten. Other highlights included: Petting a rhino; Watching the cheetahs in the reserve get fed- man do they jump high; Falling down a hill; Teaching my Brazilians English words such as "Mane," "calling shotgun," and "charge"- as in "Keep driving. That rhino looks like he might 'charge' the car;" The hippo walk; Hearing wild dogs 'laugh'; Having a full grown male lion feet from my car; And drinking almost a liter of orange Fanta. The day was actually quite amazing. I needed it badly.
Getting mugged and attacked by a lion... in the span of one week... now THAT is South Africa.
Wednesday, October 21, 2009
Monday, October 12, 2009
Donate your old cell phone: Help Mothers Save Babies
My research in South Africa involves running a support group for HIV-infected mothers via SMS (text messaging.) I need cell phones and hope you can help. Here is where, why and how it will help:
Antenatal care in South Africa, especially the Prevention of Mother-to-Child of HIVTransmission (PMTCT) program, is a perfect illustration of the complexity of HIV as a disease and, more so, the critical need for creativity in strategies to approach this epidemic. Amongst women seeking antenatal care in the country, between 30% to 40% are infected with HIV, most of these women seek care in the public (read “resource-poor, understaffed, overcrowded”) sector. Without proper PMTCT treatment, 30% of these women will have HIV-infected infant; this number rises exponentially in the first year of the child’s life if feeding guidelines are not followed. To put this in perspective, in United States, transmission is less that 1%, evidence that this number is obtainable with appropriate provision of antiretrovirals (ARV), c-sections and bottle feeding.
However, South Africa is our reminder that “medicine” entails more than throwing algorithms and a stocked pharmacy into a clinic. Currently in Southwest Tshwane, where all pregnant women theoretically have access to PMTCT, the transmission rate is greater than 15% (still lower than the national average.) To put this in perspective, in Pretoria alone, 200 babies are born every month with HIV. 200. Babies. One city. HIV.
So the question is, why are these programs failing? Why mothers leaving orphaned children when we have the ARVs to give them? Why are we routinely forcing children born into a life of chronic disease and ARV treatment? Or worse, needlessly watching them die before they reach their second birthdays?
The answer is scattered between society at large, the health care system, the strained clinics and health care workers, and, of course, the affect these things have on the behavior of individuals.
First of all, let us remember that PMTCT, like ARV therapy and highly active ARV therapy (HAART) in nonpregnant persons, is a demanding medical regimen to maintain over a period of time. Not only do the medications often produce harsh side effects and need to be taken multiple times a day, but it also requires constant follow up visits at the clinic during pregnancy and afterward. All of the components of PMTCT, which should be completed on a specific time line, face all the challenges of health care delivery in resource poor settings: lack of transport to visits, impossible waiting times, exhausted staff, problems with continuity and records of care, lack of a system to track patients, communication and education issues, space shortages, etc. These are all system issues being addressed in the Serithi Project (the larger research project I work on) but this is not enough.
Even in a perfect health care setting in South Africa, PMTCT could not function optimally. HIV is still highly stigmatized. Women who disclose their status are often kicked out of their homes or rejected by their families. Individuals do not want to be tested and, even if treatment is available, do not take it for reasons of denial or secrecy. Like other chronic (and fatal) diseases psychosocial factors faced by HIV-positive individuals run deeply, lead to social isolation and make adherence to PMTCT (including going to follow up visits or having their child tested) logistically, as well as emotionally, challenging. Indeed, the work of my preceptors and others have sought to describe phenomena such as stigmatization, disclosure status, social support, depression, self efficacy and coping styles and their possible effects on adherence to HIV treatment regimens in Southern Africa. Not surprisingly, these studies on what are known as “possible mediating factors of adherence” indicate that without addressing psychosocial factors, PMTCT fails.
In the Serithi Project workshops for health care workers which I sat in all last week, the participants were asked to brainstorm barriers to delivery of and adherence to PMTCT and then to come up with possible solutions (This is called participatory action research and seeks to give the health care workers ownership over their intervention.) Over and over in these workshops, I heard these wonderfully committed and passionate staff speak with sadness in their voice about the impact of stigmatization and the need to encourage women to disclose their status. Each workshop group wished they had more time and personnel to provide women with more counseling and one-on-one support as well as create support groups to help women struggling with PMTCT.
However, traditional “onsite” support groups just are not feasible in resource-poor settings. As stated above by the workers themselves, there just is not enough time, space or staff to implement them. In regards to patients themselves, pregnant women and new mothers have issues with transport, scheduling conflicts, lack of child care, and discomfort in the third trimester and/or the birth of the child, often forcing her to leave the group. But most notably, onsite groups fail to reach the most socially isolated women. Women with undisclosed status or great fear of stigmatization are likely concerned about breeches of confidentiality by peers in the group and are the least ready to partake in discussion. Therefore, these women often decline participation in .the groups and we miss an opportunity to support a woman who needs it most.
Here is where I come in!
My research project aims to evaluate the feasibility and acceptability of a pilot intervention using text messaging (SMS) as a means for social networking among HIV positive pregnant women in South Africa. Basically, I am running a support group for which functions solely through SMS. The technical stuff is sort of involved, but here are the basics: I am using UK-based software (ZygoHUBS) that allows a group of individuals to be simultaneously connected through SMS. Each participant will be given a phone enabled to send unlimited SMSs to a single number. When an SMS is sent to this number it is directed it to the Zygos database (specific to that number) which will then turn it around and deliver it to all the members of the given preset group. Responses will likewise be sent by SMS to the entire group. Think of it like a walkie talkie radio system except with short written messages instead of spoken and the frequency is the phone number assigned to the group’s database. So in this way, the conversation will function much like one would during a traditional on-site support group.
The idea of the intervention, like other support groups, is to bring together peers with a particular shared experience to empower, educate and support each other through dialogue. Each group will be of 8 women newly diagnosed with HIV and undergoing PMTCT, one “experienced mentor”- a woman who already went through PMTCT, and a “clinician”-who will likely be a resident or a psychology grad student with backup from a medical practitioner. The group will ideally provide an outlet to discuss psychosocial issues such as fear and stigma, converse freely about health and pregnancy, ask questions and be reminded about various components of PMTCT, hear others’ stories and learn from their choices and experiences. A similar project, Project Zumbido in Mexico, is our model and was an amazing success.
The idea is that these SMS-based peer-support groups allow for constant social support and daily peer contact while avoiding issues of transportation, childcare, scheduling or lack of clinic space or staff. Most importantly, using the aforementioned software, all discussion will take place under “code names” (on phones registered to the project,) so women will remain anonymous to each other throughout the intervention. Therefore, it is less confrontational that a regular support group and participation is completely confidentiality.
Ultimately, the goal of my intervention is to improve adherence to PMTCT and therefore decrease the HIV transmission to infants. Right now, I am working solely to provide evidence that the intervention is feasible in Tshwane, South Africa and using qualitative methods to evaluate what effect it had on women's experience with HIV and PMTCT. Ideally I will provide early evidence of the potential efficacy of the intervention by comparing measurements of before and after psychosocial factors (the “possible mediating factors of adherence”) and using records to assess PMTCT adherence. Basically though, this part of the study is to get the intervention up and running so that I can go to put it in the face of foundations and phone companies face and ask for money and involvement! Fun!
The point of all this is to show you how your old mobile phone could save a baby. (At least that is how they would say it if this was an infomercial for adopting kids from Thailand or something.) But really, I need 20 mobile phones by November. Your single phone will be a HUGE help to the me and to the project. The phones do need to be GSM phones (they need to have a removeable SIM card,) so no Sprint or Verizon. (We'll be able to unlock it to use local SIM cards here.) Compatible chargers are also appreciated, but we can buy them if you don't have one. If you have a mobile phone to donate, please send it or give it to my mom (or if you are in Providence, give it to Jason) who will collect them. My preceptor will bring them to S. Africa when he comes in November.
Susan Lach
15834 50th Ave N
Plymouth, MN
55446
You can email me or comment here if you have any questions! I appreciate all your help!
Antenatal care in South Africa, especially the Prevention of Mother-to-Child of HIVTransmission (PMTCT) program, is a perfect illustration of the complexity of HIV as a disease and, more so, the critical need for creativity in strategies to approach this epidemic. Amongst women seeking antenatal care in the country, between 30% to 40% are infected with HIV, most of these women seek care in the public (read “resource-poor, understaffed, overcrowded”) sector. Without proper PMTCT treatment, 30% of these women will have HIV-infected infant; this number rises exponentially in the first year of the child’s life if feeding guidelines are not followed. To put this in perspective, in United States, transmission is less that 1%, evidence that this number is obtainable with appropriate provision of antiretrovirals (ARV), c-sections and bottle feeding.
However, South Africa is our reminder that “medicine” entails more than throwing algorithms and a stocked pharmacy into a clinic. Currently in Southwest Tshwane, where all pregnant women theoretically have access to PMTCT, the transmission rate is greater than 15% (still lower than the national average.) To put this in perspective, in Pretoria alone, 200 babies are born every month with HIV. 200. Babies. One city. HIV.
So the question is, why are these programs failing? Why mothers leaving orphaned children when we have the ARVs to give them? Why are we routinely forcing children born into a life of chronic disease and ARV treatment? Or worse, needlessly watching them die before they reach their second birthdays?
The answer is scattered between society at large, the health care system, the strained clinics and health care workers, and, of course, the affect these things have on the behavior of individuals.
First of all, let us remember that PMTCT, like ARV therapy and highly active ARV therapy (HAART) in nonpregnant persons, is a demanding medical regimen to maintain over a period of time. Not only do the medications often produce harsh side effects and need to be taken multiple times a day, but it also requires constant follow up visits at the clinic during pregnancy and afterward. All of the components of PMTCT, which should be completed on a specific time line, face all the challenges of health care delivery in resource poor settings: lack of transport to visits, impossible waiting times, exhausted staff, problems with continuity and records of care, lack of a system to track patients, communication and education issues, space shortages, etc. These are all system issues being addressed in the Serithi Project (the larger research project I work on) but this is not enough.
Even in a perfect health care setting in South Africa, PMTCT could not function optimally. HIV is still highly stigmatized. Women who disclose their status are often kicked out of their homes or rejected by their families. Individuals do not want to be tested and, even if treatment is available, do not take it for reasons of denial or secrecy. Like other chronic (and fatal) diseases psychosocial factors faced by HIV-positive individuals run deeply, lead to social isolation and make adherence to PMTCT (including going to follow up visits or having their child tested) logistically, as well as emotionally, challenging. Indeed, the work of my preceptors and others have sought to describe phenomena such as stigmatization, disclosure status, social support, depression, self efficacy and coping styles and their possible effects on adherence to HIV treatment regimens in Southern Africa. Not surprisingly, these studies on what are known as “possible mediating factors of adherence” indicate that without addressing psychosocial factors, PMTCT fails.
In the Serithi Project workshops for health care workers which I sat in all last week, the participants were asked to brainstorm barriers to delivery of and adherence to PMTCT and then to come up with possible solutions (This is called participatory action research and seeks to give the health care workers ownership over their intervention.) Over and over in these workshops, I heard these wonderfully committed and passionate staff speak with sadness in their voice about the impact of stigmatization and the need to encourage women to disclose their status. Each workshop group wished they had more time and personnel to provide women with more counseling and one-on-one support as well as create support groups to help women struggling with PMTCT.
However, traditional “onsite” support groups just are not feasible in resource-poor settings. As stated above by the workers themselves, there just is not enough time, space or staff to implement them. In regards to patients themselves, pregnant women and new mothers have issues with transport, scheduling conflicts, lack of child care, and discomfort in the third trimester and/or the birth of the child, often forcing her to leave the group. But most notably, onsite groups fail to reach the most socially isolated women. Women with undisclosed status or great fear of stigmatization are likely concerned about breeches of confidentiality by peers in the group and are the least ready to partake in discussion. Therefore, these women often decline participation in .the groups and we miss an opportunity to support a woman who needs it most.
Here is where I come in!
My research project aims to evaluate the feasibility and acceptability of a pilot intervention using text messaging (SMS) as a means for social networking among HIV positive pregnant women in South Africa. Basically, I am running a support group for which functions solely through SMS. The technical stuff is sort of involved, but here are the basics: I am using UK-based software (ZygoHUBS) that allows a group of individuals to be simultaneously connected through SMS. Each participant will be given a phone enabled to send unlimited SMSs to a single number. When an SMS is sent to this number it is directed it to the Zygos database (specific to that number) which will then turn it around and deliver it to all the members of the given preset group. Responses will likewise be sent by SMS to the entire group. Think of it like a walkie talkie radio system except with short written messages instead of spoken and the frequency is the phone number assigned to the group’s database. So in this way, the conversation will function much like one would during a traditional on-site support group.
The idea of the intervention, like other support groups, is to bring together peers with a particular shared experience to empower, educate and support each other through dialogue. Each group will be of 8 women newly diagnosed with HIV and undergoing PMTCT, one “experienced mentor”- a woman who already went through PMTCT, and a “clinician”-who will likely be a resident or a psychology grad student with backup from a medical practitioner. The group will ideally provide an outlet to discuss psychosocial issues such as fear and stigma, converse freely about health and pregnancy, ask questions and be reminded about various components of PMTCT, hear others’ stories and learn from their choices and experiences. A similar project, Project Zumbido in Mexico, is our model and was an amazing success.
The idea is that these SMS-based peer-support groups allow for constant social support and daily peer contact while avoiding issues of transportation, childcare, scheduling or lack of clinic space or staff. Most importantly, using the aforementioned software, all discussion will take place under “code names” (on phones registered to the project,) so women will remain anonymous to each other throughout the intervention. Therefore, it is less confrontational that a regular support group and participation is completely confidentiality.
Ultimately, the goal of my intervention is to improve adherence to PMTCT and therefore decrease the HIV transmission to infants. Right now, I am working solely to provide evidence that the intervention is feasible in Tshwane, South Africa and using qualitative methods to evaluate what effect it had on women's experience with HIV and PMTCT. Ideally I will provide early evidence of the potential efficacy of the intervention by comparing measurements of before and after psychosocial factors (the “possible mediating factors of adherence”) and using records to assess PMTCT adherence. Basically though, this part of the study is to get the intervention up and running so that I can go to put it in the face of foundations and phone companies face and ask for money and involvement! Fun!
The point of all this is to show you how your old mobile phone could save a baby. (At least that is how they would say it if this was an infomercial for adopting kids from Thailand or something.) But really, I need 20 mobile phones by November. Your single phone will be a HUGE help to the me and to the project. The phones do need to be GSM phones (they need to have a removeable SIM card,) so no Sprint or Verizon. (We'll be able to unlock it to use local SIM cards here.) Compatible chargers are also appreciated, but we can buy them if you don't have one. If you have a mobile phone to donate, please send it or give it to my mom (or if you are in Providence, give it to Jason) who will collect them. My preceptor will bring them to S. Africa when he comes in November.
Susan Lach
15834 50th Ave N
Plymouth, MN
55446
You can email me or comment here if you have any questions! I appreciate all your help!
Monday, October 5, 2009
Monday, September 14, 2009
American Accent
Today I was inspired to post my first real blog ever to update any interested souls on my progress here in
The background music: “
I couldn't help but laugh and it was by far the most pleasant 4 minutes spent on hold all day. It also gave me the courage to finally stop cycle of the ritual polite exchange, which would inevitably lead to the brief explanation of my project, then to the confused pause, and then to the transfer. When the next woman picked up, I finally just said “I need to be in touch whoever would be in charge of potential partnerships or the possibility of innovative technology.” Apparently, said in an American accent, “innovative technology” has a certain authority, or maybe charm, to it and I was immediately transferred to a fellow who is going to get the company to help me with my project.
Life is good. I thank Toto.
It has been a full three weeks and I think I can now consider myself “settled.” I am already in the habit of the “How is it?” greeting before any real exchange of information, I drive a manual on the left side of the road in traffic worse than
I’ll admit, moving to a new country is frustrating. Nothing can be done smoothly since I have no knowledge of how the most basic stuff works. For the first week or so, there was one road block in front of another. Whether it is “I don’t think that is right,” (like needing South African health insurance to be a
So I’ve admitted that it is frustrating. However, it is also hilarious. Mostly, it is hilarious.
For example, one of my first quests was to get internet for my computer. The first exchange happened as I walked into a cell phone store where they sell phones, prepaid airtime cards, everything. These stores are quite common and are all very similar. It was a good place to start. After saying hello, I state simply, “I am looking for a modem which plugs into my computer and uses a SIM card to get internet.” They looked at me like I had two heads. I let a good few minutes to go by to allow them to get over the shock of my foreign accent and anything else that may have thrown them into a stupor- like the fact that I have an extra head. Then, one guy leaned onto the counter showing he was now intently focused on my words. I slowed down, “I have a laptop computer.” Head nods. “I need to use the internet on it.” Head nods. “From what I understand, there is some sort of device or modem which will plug into my laptop and allow me to go onto the internet.” More two-headed-girl stares. More silence. Suddenly, one guy’s face lights up. “OH!” he exclaims with eyebrows raised and a smile. He reaches to a shelf behind him and grabs a package. As he is handing it to me, I feel a sudden rush of joy and relief that I’ve connected with a human being and that, furthermore, I might get to have the internet. I grab the plastic and look down. It is a standard computer mouse. Not even the laser kind, the kind with the ball.
This is made even more hilarious by how simple this transaction should have been. I left that shop and walked into similar one a few doors down. They immediately pointed me in the direction of a computer shop who sold then me the modem. It did, however, take me an entire weekend to realize that, No, I did not have to storm back into the store and demand my money back for the bum modem they’d sold me, but that instead, I could just put the SIM card in right-side-up to get it to work.
The humor in these small things blows me away. Literally. My power adapter turned my miniature travel blow dryer into a hand held rocket jet,...complete with fire and the power of combustion. Though I nearly lost my face in the incident, I still laugh as I pick it up, aim it at my open window and dare, in a clicking-like language, the next human to try to get in. ... Ah yes. I’ve also seen “District 9” during my stay here. It is about aliens in
http://www.district9movie.com/
So contrary to what it may seem, I have not lost my mind. I am having a good time. I am indeed a little homesick sometimes- intensely when I try to explain that I became an “Auntie” a few days ago and then, at times, have to try the word “Nephew” with a few different intonations and even then sometimes get that look that tells me either (1) that I sound like a prawn or (2) that regardless of how I am speaking, I have grown another head in the midst of conversation. Even in these times of frustration or self-deprecating humor, I am so wildly happy to be here.... and so to South Africa I say, “Its gonna take a lot to take me away from you. Its nothing that a hundred men or more could ever do.”
Friday, August 28, 2009
Under African Skies Mass Email
Dear, well, everyone.
Congratulations! If you are receiving this email it means you are a member of an elite social group known in certain circles as "Andrea's Mass Email *To Box." More commonly known as, "The Cool Kids."
Having said this, I apologize for the generic this-is-what's-happening mass email. If you are like me, you probably want to kick me in the head about now. Let's be honest, if you are like me, you've deleted this email without even opening it, unless the subject line mislead into you into thinking it was a personalized email in which case you opened it, began reading, cursed loudly at the sender, forwarded it to your friends with a bitchy note attached and only then proceeded to delete it without reading.
The truth is, however, this email has been commissioned by many persons who wish to know the wheres, whats, whens and all those other dubs. There are certain things flying around (missionary work?! Hayley, comeon!!!) that I have no better way to clear up (Not being on facebook is Social Suicide) than to fill my one-time mass email obligation.
Therefore, Cool Kids, I invite you to enjoy the privilege that comes with your place in this exclusive club this and browse this list of frequently asked questions heard straight from the mouths of your fellow members and compiled by yours truly for your reading pleasure.
FAQs:
On the Subject of Med school:
Q: Andrea. Aren't you a doctor yet?
A: It seems like I should be, doesn't it? Afterall, I've been in school for nearly a billion years and am aging quite rapidly. However, I have one more year of medical school to compete before I graduate.
Q: So next year you'll be an MD, right? And prescribe me a bunch of fun meds?A: Your drug habit will have to go on hold for an extra year. Though I only have my 4th year of medical school to complete, I won't be starting it until 2010 and graduating in 2011.
Q: What are you doing during the next year?
A: I am a recipient of the Doris Duke International Clinical Research Fellowship from Yale School of Medicine. I will be in Tshwane, South Africa for the year participating as part of a research team as well as undertaking my own research project.
Q: I thought you were just at Yale ... wtf?
A: After I finished my last rotation at Brown, I drove to KY and then to MN, studied for and took my boards (suckas!!), flew back to the East Coast to move to New Haven where I mastered biostatics and boned up on research methods (Bite your tongue! I am very studious!)
Q: But why the hell would you tack on an extra year to med school hell?
A: Well, when you put it that way, Good freakin' question. I think I thrive off of misery. But, as the "core crew" tells me, this is actually a year away from med school doing research. Ultimately, this is as much about preparing for my career as basic science, clinical rotations and even residency.
Q: When do you go?
A: I am HERE! (I really procrastinated on this email! But now it serves the double purpose of responding to all the "did you make it ok?" emails. For those of you who did not send an "are you safe?" inquiry. Yes. I am. Thanks.) I'll be here until May.
On Research:
Q: Are you tired of telling people about what exactly it is you will be doing in S. Africa?
A: No i am not. But thanks for the concern.
Q: So....?
A: Oh! My work is surrounding Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs. Basically, even in urban areas where proper ARVs and HAART is available and women are actually seen at clinics during pregnancy, the transmission rate here still really sucks (about 15%. In the states it is .001%) This is due to a lot of structural problems of resource-poor settings which affects delivery of PMTCT but also due to psychosocial factors faced by women that affect their adherence to PMTCT.
The large study I will be working on involves implementing large scale interventions at clinics to improve PMTCT delivery and adherence. My own study is trying to find new and innovative ways to support women during their pregnancy to increase PMTCT adherence. It is a feasibility study in which I will be running a support group via text messaging to see if this is a better approach due to women's limited mobility and other logistical barriers to "physical" support groups.
Q: So you get to go to S. Africa AND you get to text message the entire time?
A: Sweet deal, huh?
On other S. Africa work:
Q: Will you get to do any clinical work?
A: Yes. I am registered as a University of Pretoria medical student and I am invited to do as much or as little clinical work as I want. I plan to do a lot to get a better feel for international health and what would be the proper speciality in which to train. (Thank you Luther College, for making vocation something so complicated.) I especially want to spend time in the neonatal nursery and outpatient clinics and the ER.
Q: Are you sure you brought enough professional dress of being in the hospital?
A: I have plenty of modest blouses and knee length skirts.
Q: You'll be working with HIV, are you going to get AIDS? (I'm going to go ahead and give a shout out to Nana on that one.)
A: No. No, I will not. Apes maybe. But not AIDS.
South Africa logistics:
Q: Where is Tshwane?
A: It is what used to be called Pretoria. It is the municipal capital of S. Africa and right next to Johannesburg.
Q: Will you be home for Christmas?
A: I know that Santa is getting me a really cool gift called "Nephew" which I'd love to come home to see. However, I am not making any promises and may use the holiday to travel to places where jet lag won't be such an issue (Paris in December?!)
Q: Where will you live?A: I am living in the medical school dorms near the medical campus. They are SWEET! Plus, S. African medical students are REALLY well dressed and nice to look at. Brown Med 2010 could take a few pointers.
Q: Where are your kitties? (I would not normally have included this question, but I must admit that it is indeed the most FAQ.
A: I brought them to KY to live with my sister-in-law to beat up her dog. My plants, too, are also safe with multitudes of friends... I know you were worried.
Q: Will you have time to travel?
A: I will make sure of it. If anyone wants to meet me anywhere, let me know. Ghana and Madagascar are among my stops.
Q: Will you have Internet?
A: No. Unfortunately my hut does not have electricity and the country of Africa has not yet discovered these modern forms of communication.
Q: Will you blog while you are there?
A: I do not believe I have anything interesting or important enough to say that it must circulate through cyberspace for all to read. If I have something clever to say, I'll send you the link to my craigslist post.
Q: Please...?
A: Here is the link to my blog that I have never once used: http://alachdean.blogspot.com/ I, again, make no guarantees, but I will try to occasionally let you know I am safe and well... I, at least, promise to use the blog as an alternative venue if I have feel the need to do this sort of thing again.
All right everyone. I hope this email has served your purposes and no one feels left out of the loop. Most importabntly from this email is a PLEA that if here is ANY news (good or bad) that I should know about, please do not wait until I land back in the states before you spring it on me. I understand that extreme circumstances call for extreme measures, but mostly PLEASE let me know if anything happens. I know I will be missing some weddings and births and that sucks. Keep me up to date anyway!
I love you all and am so glad that you are so goddamn cool.
Andrea
Congratulations! If you are receiving this email it means you are a member of an elite social group known in certain circles as "Andrea's Mass Email *To Box." More commonly known as, "The Cool Kids."
Having said this, I apologize for the generic this-is-what's-happening mass email. If you are like me, you probably want to kick me in the head about now. Let's be honest, if you are like me, you've deleted this email without even opening it, unless the subject line mislead into you into thinking it was a personalized email in which case you opened it, began reading, cursed loudly at the sender, forwarded it to your friends with a bitchy note attached and only then proceeded to delete it without reading.
The truth is, however, this email has been commissioned by many persons who wish to know the wheres, whats, whens and all those other dubs. There are certain things flying around (missionary work?! Hayley, comeon!!!) that I have no better way to clear up (Not being on facebook is Social Suicide) than to fill my one-time mass email obligation.
Therefore, Cool Kids, I invite you to enjoy the privilege that comes with your place in this exclusive club this and browse this list of frequently asked questions heard straight from the mouths of your fellow members and compiled by yours truly for your reading pleasure.
FAQs:
On the Subject of Med school:
Q: Andrea. Aren't you a doctor yet?
A: It seems like I should be, doesn't it? Afterall, I've been in school for nearly a billion years and am aging quite rapidly. However, I have one more year of medical school to compete before I graduate.
Q: So next year you'll be an MD, right? And prescribe me a bunch of fun meds?A: Your drug habit will have to go on hold for an extra year. Though I only have my 4th year of medical school to complete, I won't be starting it until 2010 and graduating in 2011.
Q: What are you doing during the next year?
A: I am a recipient of the Doris Duke International Clinical Research Fellowship from Yale School of Medicine. I will be in Tshwane, South Africa for the year participating as part of a research team as well as undertaking my own research project.
Q: I thought you were just at Yale ... wtf?
A: After I finished my last rotation at Brown, I drove to KY and then to MN, studied for and took my boards (suckas!!), flew back to the East Coast to move to New Haven where I mastered biostatics and boned up on research methods (Bite your tongue! I am very studious!)
Q: But why the hell would you tack on an extra year to med school hell?
A: Well, when you put it that way, Good freakin' question. I think I thrive off of misery. But, as the "core crew" tells me, this is actually a year away from med school doing research. Ultimately, this is as much about preparing for my career as basic science, clinical rotations and even residency.
Q: When do you go?
A: I am HERE! (I really procrastinated on this email! But now it serves the double purpose of responding to all the "did you make it ok?" emails. For those of you who did not send an "are you safe?" inquiry. Yes. I am. Thanks.) I'll be here until May.
On Research:
Q: Are you tired of telling people about what exactly it is you will be doing in S. Africa?
A: No i am not. But thanks for the concern.
Q: So....?
A: Oh! My work is surrounding Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs. Basically, even in urban areas where proper ARVs and HAART is available and women are actually seen at clinics during pregnancy, the transmission rate here still really sucks (about 15%. In the states it is .001%) This is due to a lot of structural problems of resource-poor settings which affects delivery of PMTCT but also due to psychosocial factors faced by women that affect their adherence to PMTCT.
The large study I will be working on involves implementing large scale interventions at clinics to improve PMTCT delivery and adherence. My own study is trying to find new and innovative ways to support women during their pregnancy to increase PMTCT adherence. It is a feasibility study in which I will be running a support group via text messaging to see if this is a better approach due to women's limited mobility and other logistical barriers to "physical" support groups.
Q: So you get to go to S. Africa AND you get to text message the entire time?
A: Sweet deal, huh?
On other S. Africa work:
Q: Will you get to do any clinical work?
A: Yes. I am registered as a University of Pretoria medical student and I am invited to do as much or as little clinical work as I want. I plan to do a lot to get a better feel for international health and what would be the proper speciality in which to train. (Thank you Luther College, for making vocation something so complicated.) I especially want to spend time in the neonatal nursery and outpatient clinics and the ER.
Q: Are you sure you brought enough professional dress of being in the hospital?
A: I have plenty of modest blouses and knee length skirts.
Q: You'll be working with HIV, are you going to get AIDS? (I'm going to go ahead and give a shout out to Nana on that one.)
A: No. No, I will not. Apes maybe. But not AIDS.
South Africa logistics:
Q: Where is Tshwane?
A: It is what used to be called Pretoria. It is the municipal capital of S. Africa and right next to Johannesburg.
Q: Will you be home for Christmas?
A: I know that Santa is getting me a really cool gift called "Nephew" which I'd love to come home to see. However, I am not making any promises and may use the holiday to travel to places where jet lag won't be such an issue (Paris in December?!)
Q: Where will you live?A: I am living in the medical school dorms near the medical campus. They are SWEET! Plus, S. African medical students are REALLY well dressed and nice to look at. Brown Med 2010 could take a few pointers.
Q: Where are your kitties? (I would not normally have included this question, but I must admit that it is indeed the most FAQ.
A: I brought them to KY to live with my sister-in-law to beat up her dog. My plants, too, are also safe with multitudes of friends... I know you were worried.
Q: Will you have time to travel?
A: I will make sure of it. If anyone wants to meet me anywhere, let me know. Ghana and Madagascar are among my stops.
Q: Will you have Internet?
A: No. Unfortunately my hut does not have electricity and the country of Africa has not yet discovered these modern forms of communication.
Q: Will you blog while you are there?
A: I do not believe I have anything interesting or important enough to say that it must circulate through cyberspace for all to read. If I have something clever to say, I'll send you the link to my craigslist post.
Q: Please...?
A: Here is the link to my blog that I have never once used: http://alachdean.blogspot.com/ I, again, make no guarantees, but I will try to occasionally let you know I am safe and well... I, at least, promise to use the blog as an alternative venue if I have feel the need to do this sort of thing again.
All right everyone. I hope this email has served your purposes and no one feels left out of the loop. Most importabntly from this email is a PLEA that if here is ANY news (good or bad) that I should know about, please do not wait until I land back in the states before you spring it on me. I understand that extreme circumstances call for extreme measures, but mostly PLEASE let me know if anything happens. I know I will be missing some weddings and births and that sucks. Keep me up to date anyway!
I love you all and am so glad that you are so goddamn cool.
Andrea
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