Thoughts at the end of week one

Tuesday: Greeted by a marching band

The first thing I saw when I made it through customs (and sadly gave up my Emirates Airlines cheddar cheese) was a throng of paparazzi and a marching band. A local rugby team had just won the World Cup and was on my flight. I’m on the lookout for a celebratory parade in the next few days.

And I got one additional piece of advice: no walking alone after dark, not even to the store down the block. Clearly I'm not in Squirrel Hill anymore . . .

Wednesday-Friday: Working & a little bit more about what I do

Things are off to a good start here. I met the professor yesterday, and I think we will work well together. She was glad to hear that my apartment was across the way, because she had set up a 7:30 a.m. teleconference for me on Monday. She will be out of town, so I will be introducing the study to our nine(!) research assistants, one in each province. The purpose will be to give them instruction on how to administer the survey and to set goals for each area. It’s kind of intimidating, the idea that I will be taking the lead on this and supervising nine people around the country.

So far, work has mostly consisted of a literature review – a largely disheartening look at how difficult it is for AIDS patients in developing nations to access essential medicines. One study noted that 4% of AIDS patients in urban South Africa received anti-retrovirals (what we think of as standard AIDS care in the States), with perhaps 30% receiving adequate relief for their most common and debilitating symptom: pain.

There are a few bright spots in the literature, though, mostly borne of activism on the part of health care providers. Uganda, for example, passed a law in 2004 allowing certified palliative care nurses to prescribe morphine, bringing pain relief to rural areas in particular. This came about in part because of the serious physician shortage there: 1 doctor for every 50,000 Ugandans. For comparison, there is 1 doctor for every 400 Americans.

There are many components to increasing access to palliative care here, but the Ugandan system provides a good starting point.

In other news, Tuesday I will go with the fourth-year medical students* on their hospice rotation to St Luke’s. I’m not sure what this entails exactly, but I know that I am not cleared to do anything clinically—nor should I be! I am certain that it will be a valuable experience, and it will be nice to spend the day with some peers.

*Theirs is a six-year program, so we are at nearly equivalent points in our education.