Monday, July 11, 2011

Week 1 update

Apologies for my radio silence over the last week as I adjusted to life here in Bots. Part of it is that I have so much to say that the thought of condensing it into a few posts is overwhelming. But before I work myself into a tizzy-I thought I’d start with the basics: what I’m doing here and what my schedule is. One of the coolest things about this trip is the fact that I’m pretty much in charge of myself. I was sent here to help with the vulvar cancer study but I’ve already gotten to dabble in so much more:

1. Vulvar Cancer study*.
This project is examining viral contributors to cancer of the vulva. Much like cervical cancer, researchers think that oncogenic (cancer causing) viruses like HPV could lead to vulvar cancer, especially in immunocompromised hosts (like patients who are HIV+ with low CD4+ counts).

This study has two arms- a retrospective arm where we are looking at tissue samples of past patients and a prospective arm where we enroll patients with newly diagnosed vulvar cancer. In terms of the retrospective study, my job is to go to the national pathology laboratory (across the street from Princess Marina Hospital (PMH) in Gaborone and look through the biopsy books for cases of vulvar cancer. It may not sound that exciting but it is kind of cool to comb through biopsies and see the names of things that I learned about during my first year (teratomas, pheochromocytomas, fibroadenomas etc).

The pathology lab! 
One of the biopsy books that I've been looking through. I've left it blurry and cut off any identifiable patient information but just wanted you to get a sense of the record keeping system.
 For the prospective study, my job is to be a liaison between dermatology and gynecology to make sure that we don’t miss any cases of this very rare cancer. So far this is proving to be the most difficult part of my job but I’ll post more about that later.

*Note: for those of you who don’t know (or who missed my saying “genitalia” on live TV), the vulva is the external female genitals.

2. Dermatology clinic. One of the best things about coming to Botswana is the opportunity to work with Penn derm residents in the dermatology clinic at Princess Marina Hospital (PMH) in Gaborone. It’s an outpatient clinic and we see an average of 15-20 patients per day. On Thursdays we go to “outreach” clinics in other sites. Given that I am a lowly first year medical student, my job is basically to help with the paperwork and learn as much as I can. My first week I worked (and lived) with two Penn residents: Jen and Doug. Jen has been here before and came to show Doug the ropes. Lucky for me because she was truly an amazing teacher. At school I’m looked at as kind of weird for my interest in abscesses and scaly skin but living with two derm residents means I get to really nerd out and discuss HPV, scleroderma and psoriasis to my heart’s content. 

 Jen, Doug and one of the nurses in the room where we have derm clinic.

3. Etc. Given my flexibility and the fact that I want to stay busy- I’ve been on the lookout for other projects and ways that I can help. To that end, I’ve been helping my friend and PennMed 4th year Aileen Chang with a “mobile learning” project dealing with smartphones that have been distributed to several doctors in Botswana. So far I’ve been helping update the phones with the relevant medical “apps” (luckily the phones are Androids like my phone at home so I’m familiar with the interface) and it’s been quite enlightening. I’ve even downloaded some of the apps for my own phone and have been using it in clinic.

Lastly, I’m helping install an awesome computer program called VisualDx that helps doctors with tricky dermatology diagnoses. This is a challenge because the hospital has very few fast, functional computers on the wards so we’ve decided to install it in the hospital library to start with and go from there. 
The PMH library where we've installed the VisualDx software. Next steps: play around with the software myself and then train some residents/docs how to use it. 
As you see, I’ve been trying to keep busy and I come home pretty exhausted with a long to-do list but to me there is no better feeling. I feel happier and more fulfilled than I have in awhile, actually.

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