Blog
2:
Today,
I finally met Hannah Harp, my SCORE mentor. She was relieved that Genna had
given me ample material to read and to become familiar with, so that we could
jump right in. I had taken notes and highlighted, circled and wrote questions
on the papers I read, so I asked Hannah the questions I was not able to find
answers to on my own, after looking online and talking with various people.
I
did some more reading on my own last night, on the main countries that the MGH
GHHR focuses on, such as South Sudan, Uganda, and Kenya. I presented my notes
to Hannah, explaining to her what I read and giving my opinion and how
different aspects of life there made me think differently about how I live in
the United States. For instance, the controversy surrounding female genital
mutilation. In AP Psych, we talked about the term "framing", which
more or less means the way someone presents something, such as the "glass
half full" versus the "glass half empty". The anecdote from
psychology class is relevant, because the term "female genital
mutilation" elicits horror and shock, when in reality, if performed in a
sanitary, medical environment, it is similar to having a male's penis
circumcised. For me, it was almost surreal, when I realized this, because as a
woman, it seems so foreign, to think of that procedure done to me, despite the
fact that most men in America are circumcised. I think it's an essential part
of working in a place the MGH GHHR to be able to sit back, think about
something, and realize the connection between one culture's customs and
another's, and piece them together, to the point of realizing that maybe people
aren't so different after all.
Blog 3:
Today,
there were two radiologists that are visiting the United States for four months,
in the office. Gladys and Patricia are both from Kenya, and are kind, but high
maintenance. I felt sorry for Hannah, because she is a research assistant, but
the two women treat her like their own personal secretary, and demand she get
them phones, schedule transportation, and call her at all hours of the day for
truly lilliputian tasks. Hannah complies with it, because she virtually has no
choice, but I can't even imagine how frustrating it must be for her.
The
ladies wanted to see MGH, and I hadn't really seen it before either, aside from
having been to the ER for a family matter, once, so I was looking forward to
seeing it. Hannah and Chol - one of the medical students I mentioned in my
first blog, who will be one of the first doctors in South Sudan - showed us
around.
MGH
prides itself on its focus on research, and has earned its reputation for being
the place of many "firsts". For instance, it was where the first
ether surgery took place, meaning it was the location of the first anesthetized
surgery. The patient had a tumor in his cheek, and the dentist and surgeon were
there - it isn't like modern day, where there are oral surgeons - and a sponge
of sorts was dunked into ether, waved in front of the patient's nose, and it
knocked him out.
The
"surgical theater", as it was called, is still intact, and has become
a museum of sorts, which we visited. There is a painting, that accurately
portrays how the surgery was carried out and who participated, and what I found
amazing was that the doctors wore suits, full suits, to operate. It's strange
to think that doctors didn't always wear scrubs, and they didn't always have
gloves and sanitary products, and sterilization. They would hope from patient
to patient, with one's blood on his hands as he went to the next. What's more
remarkable, is that even now, in the year 2013, there still are thousands of
doctors that do not have those luxuries. Gladys pointed out that it was only
relatively recently, that washing hands became routine, which is scary when I
think about it.
Finally,
we went to the MGH Museum, which, I never knew even existed, but apparently, it
is still pretty new. It was a small, but phenomenal, and interactive place. I
was able to "diagnose" patients and read up on the other
"firsts" of MGH, and label blood cells and parts of the brain.
Blog 4:
The
office was very crowded today. For some of the day, the radiologists, Gladys
and Patricia, came in, to get their phones and white coats, and to fill out
paperwork, as well. Additionally, there were two students from Milton Academy
who are going to the Bahamas for six weeks for research this summer, with
epidemiologist Dr. Ahn, one of the doctors in the office. They had to fill out
paper work, as well, and went out to lunch with a visiting researcher, Brent,
and Dr. Ahn. Furthermore, Chol was here, too, with Karen and Andy.
Chol
is a South Sudanese medical student, who met Dr. Thomas Burke, the Director of
the MGH GHHR, while in South Sudan, and befriended him. Chol and Dr. Burke are
currently writing a book about their friendship, and what has come out of it,
in terms of the efforts locally. Karen is the one writing the book, and she and
Andy, of True Story Media, also do the filming of the documentaries and video
clips for the MGH GHHR projects.
It's
interesting, because I can hear and see Chol answering Karen's questions, and
they both become irked because Karen expects Chol to always know
"why" certain traditions are the way they are, and he doesn't - just
like we do things we don't really know the "why" of. Chol was telling
me before, that he used to walk days at a time to get to school, even as a
young child, and Hannah said that he would be learning biochemistry in the
dirt.
Chol
had grown up in a nomadic community, and for a few years, until he was about
12, he worked at a cattle camp. He didn't even learn how to read or write until
he was that age, and now he's going to be a doctor. I find that motivational,
inspirational, and mind-boggling, to be honest. I mean, I used to complain
about walking to the bus stop in the snow, which pales in comparison, of
course. His father had three wives, and he is one of 7 or 8 children, I
believe. He explained that when a child is born, a goat is slaughtered
centrally in the village, and the head is given to the old men and the women,
for wisdom, because they eat the brain. Hannah worked in El Salvador throughout
college, and she said that as the guest at someone's house, she was given the
pituitary gland.
Blog 5:
I
finally met Dr. Burke and Dr. Ahn today, and as cheesy as it may sound, I
honestly felt like I was meeting celebrities, because it is truly remarkable
what this department does. For instance, Chol is a medical student, is here in
another country, and is writing a book; Genna is going to nursing school, works
for Planned Parenthood, and does the grunt work for Dr. Burke and Dr. Ahn;
Hannah is going to start medical school this summer, and also does the grunt
work, and worked in El Salvador for years, doing community based projects; Dr.
Ahn is an epidemiologist and is the logistical person and is hands down the
most efficient human being I have ever met, and is going to the Bahamas for
research, and Dr. Burke is the Chief of both the Emergency Department at MGH
and the MGH GHHR, is writing a book, spends time in the office in meetings,
then works until 3am at the ER, and is going to Kenya for the summer with
Harvard students for research. No one sleeps, they live on yogurt, and they are
generally positive, funny, and genuine people.
SCORE
truly has been one of the most valuable tools of my high school career, because
it is showing me what I want and what I
don't want and what I need to do to achieve my goals. More specifically, before
starting SCORE, I knew I had an interest in global public health, but did not
yet know as to what capacity I wanted to work in: research or medical.
Since
being here, I have decided that I do in fact want to become a doctor, and I
will apply for the five year medical program at NUIG in August. While I enjoy
research and asking and answering questions, I have confirmed that being a
doctor is truly what I want, and have finally gained the confidence in myself
to pursue that.
Blog 6:
Hannah
has been teaching me how to successfully conduct a literature review. Her
approach is much more hands-on than that of my ASR mentor, which is great, and
isn't to say that I don't value my ASR internship, it's just that this is a
better suit for me. She gave me helpful hints as to how to search more
efficiently on PubMed, such as adding asterisks, tildes, "AND",
"OR", and "NOT", as well as using quotations, and question
marks. I cannot even express how much time these shortcuts will save me,
because they cut down the results from thousands to a few dozen, which is much
more doable.
Hannah
also suggested that I record the search terms used, the date of the particular
search, the number of the initial results yielded from the search, and how many
were actually viable, which I did do, because in a literature review, this is
what is important to include.
I
also had to write a small section, explaining what is included. This means,
basically, identifying and explaining to the reader, the particular cohort the
review is focused on. My inclusion criteria, for instance, is "malnourished HIV
positive pregnant women residing in Sub – Saharan Africa with no known
coexisting diseases, written in English".
I developed this inclusion criteria
as a harmony based on what my interests were and what materials I was given and
found to read. I initially had an interest in HIV and Hannah and I went back
and forth brainstorming questions, and the ones that had numerical answers were
weeded out, because that means I can't write a review on them. Eventually, I
decided on what I was most intrigued by, and strung it together to determine
the criteria.
Blog 7:
In
addition to showing me how to narrow down and filter out my searches on PubMed,
Hannah also taught me to look at the references in the papers I found helpful,
to see if they cited anything relevant and useful to my search; this process is
called secondary research. Hannah sent me a copy of a literature review that
she did, not too long ago, this morning, so that I could have an example handy
to consult, if I needed a clearer picture as to what I was doing.
The
most valuable material item I have discovered, is my passion for sticky
notes/organization/planner. I have become a crazy labeler, because it is
necessary, when constructing a literature review. I have various folders in
different binders, coupled with the plethora of sticky notes I use, and
different pens to synchronize the information I'm reading and what I need to
take note of.
As
much as one might laugh at me saying this, the hardest part of all of this, is
truly eliminating excessive information. It's difficult, because the relationship between malnutrition,
poverty, education, healthcare, maternal health, and disease (such as HIV) is
cyclic, meaning that one leads to the next, so it is hard to determine where to
cut short the information. I need to do this for the background section of my
literature review, because I need to explain "the problem", which I
have identified as being the trifecta of public health concern: maternal
health, malnutrition, and HIV, particularly in Sub - Saharan Africa.
Blog 8:
The
other most challenging aspect of SCORE, is the patience required to do a
thorough literature review. For example, if I am reading a paper on vitamin A
deficiency, and the paper cites another paper, to be thorough, I need to find
that cited paper in the references, copy and paste it into PubMed, find it,
then find the full version for free somewhere, print it, and skim it, to find
the section that quotes what I want. Despite it being agonizingly time
consuming and tedious, it is essential, and it's a worthwhile habit to develop,
in order to do a proper literature review.
Today,
I was able to sit in on a meeting that Dr. Burke and Dr. Ahn had, with a
radiologist, from MGH, I want to say, but I honestly can't quite remember. In a
previous blog post, when I was listing the current projects and endeavors of
both the people in the MGH GHHR individually and collectively, I forgot one
monumental achievement: the department has basically implemented an entire
emergency medicine department in Sagam. This meeting that I was privy enough to
listen in on, was about the potentiality and feasibility of developing a
radiology department.
It
was interesting to watch the three of them - Dr. Burke, Dr. Ahn, and the
radiologist - go back and forth with each other and think so rationally and
deliberately on the spot. They suggested things and immediately the ideas were
bouncing back and forth about why something may work, why it might not, the
funding, the practicality, and so on. For me, to think of all they did so
thoughtfully, it would take hours, but I suppose that when you only have a few
minutes for a meeting, you have to make every second efficient and productive.
Blog 9:
Today
was more of a sentimental, laid back day at the office, because I learned more
about everyone's personal lives.
Hannah
is one of ten children, which I found incredible, because my grandmother was
one of seventeen kids, so I was surprised that nowadays someone who have that
many kids. Genna has two
sisters, and he father committed suicide when she was in her sophomore year of
college. Consequently, her mother and youngest sister live nearby, and she
currently lives with her other sister, who just earned her Master's in Public
Health.
Dr.
Ahn works 8:30am-5:30 pm Monday - Friday, and works from home for about an hour
or two on weeknights and most of Saturday, but somehow still manages to get his
family ready in the morning for school and spends time with them when he can,
which is pretty impressive, if you ask me, considering the colossal amount of
work he does, and even when he isn't, he's on his phone and calling or texting
new ideas.
Finally,
for Dr. Burke, it's just easier to count the hours in a day that he isn't
working. As I have said, Dr. Burke is an ER physician at MGH, and is the chief
of the GHHR division, as well as of the ER department. He is also the medical
director of a chartered plane group, that charges upwards of $70,000/person to
go on trips for about a month, to different places worldwide. So he oversees
the doctors that accompany those travelers, and sometimes is the doctor on
them, as well as writing the book. Dr. Burke is like the energizer bunny. For
instance, yesterday, he was in the office all day until 4pm, in the office
meaning maybe in another office having meetings, but still, working for the
GHHR. Then at 4pm, he left to go to the ER and worked a shift until 3am this
morning, and will be in the office any moment now, and has this same schedule
for the next 9 days. The man never sleeps. However, despite his massive
accomplishments and impressive resume, that comes at a price. He's only just
recently been married, at 52, because he never had the time really to date
anyone, and his wife lives in Washington, and is a pediatrician, so they don't
have much time for one another. He used to live on his boat in the navy yard,
because it was easier to walk there after a shift than going to a house, which
he only just recently bought.
Blog 10:
Today,
Genna and I went on a little road trip into the financial district. We went
because a large consulting firm down there donated 50+ laptops to medical
students/ hospitals in Sagam. The laptops were already brought to the office a
while back, but there were still 12 laptops that were not properly "wiped",
meaning that there was still encryption and coding on the laptops, in turn,
making them inaccessible, so we had to return them to the consulting firm, to
have their IT department take care of.
First,
we had to drive to Medford, to go pick up the laptops from Dr. Burke's house,
as they were in his car, in his garage. It was a nice drive, not too far away,
and Genna and I had a heart - to - heart and shared high school stories. Once
we arrived at Dr. Burke's, we had to figure out the combination for the lock
for the garage, and then we loaded the laptops from his car into Genna's car.
Afterward, we drove to the consulting firm, and we were in a pickle, because we
couldn't find parking, and 12 laptops weigh a lot, and there were only two of
us. So Genna parked illegally, by a loading dock, and I waited in the car.
Genna carried all 12 up at once, and at one point, used the side of the
building to readjust the boxes. I found it terrible that everyone who passed
her gave her a look, as though to say, "What are you doing?", and
yet, no one even offered to help her. In fact, two smartly dressed young men
walked by her, checked her out, then made obscene gestures; I thought of how
inappropriate that was, but also just how wrong it is that they would do that,
but would not offer help.
Before
Genna had gone up, she left her phone, so I could call up to the office if I
had to, and said I could move the car if needed. I told her that I was more of
a country road person, braking for turkeys person, not a city driver,
especially during lunch hour. Sure enough, the meter maid walked over, tapped
my window, and told me to move, and I politely said that my boss would be right
down, and then we'd be leaving. Shortly after, Genna comes back to the car and
says that the IT desk associate would not take the laptops because she didn't
have her ID on her, so she had to come back down to the car to get that and
then go back up. We drove around the corner, and illegally parked again, and
naturally, the same meter maid came over, and said she was glad we had moved,
but that we need to move to somewhere we actually can park, and thankfully,
Genna ran to the car and we made our escape.
Blog 11:
When
Dr. Burke is not in the office, I am able to use his own private office to do my
work, which is wonderful, because then I do not have to be constantly shuffling
my papers and reorganizing every time someone comes in to the general office
and wants to sit at the table.
Being
in his office, I can see his personal library, and I have written down the
names of a few books I hope to read this summer, to further expand my knowledge
in public health. He has a good collection, it seems, from memoirs to manuals,
to the history of particular epidemics and diseases, as well as books on human
trafficking and defining the rights of people for healthcare and treatment.
I
am currently working on a summary I am turning in to Hannah, about the HIV/AIDS
epidemic in South Africa. At one point, ~30% of pregnant women in South Africa
were infected. Despite the prevention of mother - to - child - transmission
(PMTCT) program being "implemented" in South Africa in 2002, it did
not garner attention or momentum until about 2008, and the summary I am putting
together, will answer that, as it does not make sense, to at least me,
personally, as to why a country with such an alarming number of infected
citizens, would not want to strengthen and reinforce an initiative like the
PMTCT program. The more I read about South Africa, the more information I
gather to support the summary and my contentions for the lag in effort.
Blog 12:
I have finished
the summary I put together for Hannah, which organizes the cause and effect of
recent events, in a basic way, and just outlines the key points of issue and
success. I found working on this summary to be very intriguing, because the
country of South Africa has the highest number of women infected with HIV. In
fact, in 2010, 30% of pregnant women nationwide were tested HIV positive,
causing approximately 70,000 babies to be born HIV positive, as well, with an
increased risk of childhood death, as HIV is associated with 50% of deaths for
children under 5 years old.
The major attempt to combat the HIV
epidemic in South Africa, was the PMTCT program initiated in 2002,
significantly later than that of other countries. Furthermore, it was not until
2008, that the program gained momentum, as I said in my last post. The primary
reason for the deficit of adequate development was due to the lack of clear
support of government involvement. The president was fickle about his personal
and political stance on HIV/AIDS, and resigned himself multiple times from
involvement. The government also adamantly refused to accept that HIV causes
AIDS, and denied that it was and still is an epidemic. The government also
rejected donated aid and medical treatment. This nebulous reaction to the
epidemic hindered productive intervention and treatment for six years, and is
described to be an “attitude of defiance”, (Schneider, Fassin).
After 2008, under new leadership,
there was a noticeable mark in improvement. In 2008, the Minister of Health
launched the PMTCT accelerated plan (A-Plan), which was aimed to reduce the
transmission from 12% in 2008 to ≤5% by 2011. In 2009, President Zuma’s speech
on World AIDS Day demonstrated clear support of government involvement in the “war
on HIV/AIDS”. Finally, in 2010, more women met the criteria for coverage under
HAART.
Blog
13:
This morning, I was reading more on
South Africa, and one paper really captured my attention. One question asked in
the paper is why is HIV mostly transmitted heterosexually in South Africa,
despite being transmitted homosexually, elsewhere? The answer can mostly be
broken down to birth control, infrastructure, protection, treatment, the
prevalence of poverty and co-existing diseases. Birth control is a common issue
because women do not have the accessibility to it, because of social factors,
laws, poverty, and lack of education, healthcare, and transportation, pride,
dowry, and religion. Consequently, they have more kids, and abortion is seldom
an option, sometimes resulting in mothers consciously not seeking treatment for
their children, and deciding to take food from her unhealthy children to give
to her healthy children, as a means of keeping the ones most likely to survive.
I think it is important that the
paper addresses that question, because there is still a harsh stigma on those
infected with HIV/AIDS, which is unfortunate. People need to realize that there
are plenty of HIV/AIDS infected persons who contracted it from birth or blood
transfusions or unsterile equipment. Especially in the United States, there is
a stereotype that all HIV/AIDS positive persons are Caucasian gay men who have
unprotected sex, or are "wild" people somewhere in the great depths
of Africa, which clearly is not the case. In college, I hope to be a part of an
HIV/AIDS organization or foundation, and hopefully do my part in sharing
knowledge with others about what it truly is, to spread awareness, and to
encourage understanding and tolerance.
Blog
14:
This afternoon, Genna, Hannah, and I
went out for lunch together. It was nice actually because we got to loosen up
from a busy day, with everyone in and out of the office. Hannah apologized
profusely for having to call out sick yesterday at the last minute, because of
a migraine, which I told her not to worry about, because I had plenty to do on
my own, and the great thing about research and literature reviews, is that it
mostly is just independent work, which I like. I prefer working independently,
but having other people in the office, so that it is still entertaining but
also educational, because I can always ask either Hannah or Genna for help if
need be. I could completely empathize with Hannah, because, like her, I suffer
from migraines, as well, which are no easy thing to overcome.
Tomorrow, I'll do more of a
comprehensive summary of my experience at my SCORE internship, but I will say
that one skill, among many, that Hannah and the MGH GHHR have taught me in my
five weeks here, is the value of cooperation, patience, and self - control.
There have been plenty of times where Hannah and Genna have been treated
terribly by superiors (not in this office) and they vent to each other and to
me, but then get right back on the phone and act as though nothing happened,
still chipper and willing to please, which is commendable. It's important to be
able to be so flexible, because if you cannot manage to get along with
colleagues or to communicate effectively, then working is a wash, because it
won't be hardly as productive, and can make for an agonizingly long day.
Blog
15:
I can't believe that this is my last
post, already. I have to start out, by saying how incredibly grateful and
appreciative I am for having had the opportunity to work with the MGH GHHR and
Hannah, in particular. I see what other people have been posting, and it's
remarkable as to how many people have been anticipating the end of SCORE,
whereas I don't want my SCORE project to end. I could honestly see myself
working here for sure when I have already practiced for twenty - odd years and
want a change of scenery.
Hannah has taught me so much, it's
difficult to capture and put into words, because I'm sure that I don't even yet
know quite everything I have learned. She has taught me how to better conduct
literature review and how to more efficiently search, with all of the search
term tips she gave me. In addition, because of being in such an environment, I
was able to finally decide that medical school is where I am meant to be, and
so I will apply in August, to do the six year medical program at the National
University of Ireland, Galway, which is where I will be studying biomedicine
this year. Furthermore, she has given me amazing insight and advice, such as
repeating to me the advice her friend's dad once told her years ago, that it's
important to always work harder than your boss, which I do find to be good
input. Finally, she has also given me the scoop on everyone in the office, in
the sense of "this is what ___ accomplished", but "this is what
it cost him/her", so it is well balanced information and suggestions. I
finally got my MGH GHHR fleece, too!
Since freshman year, the only two
things I was really looking forward to in high school, were my ASR internship,
and my SCORE project. I can honestly say, that SCORE has by far exceeded my
expectations. I just wish it had been for longer.
