Busy days and chance encounters

UNC Project is a dynamic place. It's a 2 story building, aptly named, "Tidziwe Centre." Tidziwe means "we should know" in Chichewa and everywhere inside are people trying to learn new things. On the first floor is the lab where on the microbiology side lab technicians are looking through microscopes, gram staining samples to identify organisms, and growing cultures in the incubators. On the chemistry lab techs use state of the art equipment to perform blood counts, blood chemistries, CD4 counts. Study clients sit in the hallways -- women wrapped in multi-colored chitenjes breastfeed their babies and smile as you walk by. Clinicians in white coats scurry between the rooms, consulting their colleagues and seeing the study clients. A television plays Malawian music videos that toddlers (and occasionally adults) dance to in the hallway. On the second floor offices surround a large lecture hall. Study coordinators and managers work 3-4 to an office, the walls stacked with books and journal articles, utilizing every square inch. A library houses books and medical journals and an internet connection that is directly linked with the Health Sciences Library at UNC in Chapel Hill.

The project is a dynamic place, but quiet places to work are in short supply. While my study was going on I spent most of my day in the data room up at the STI clinic. The data room is approximately 3 feet by 4 feet and windowless, and housed two desktop computers, two tables, three chairs, and two four-drawer filing cabinets in this space. My friends back in NC imagined my work overseas as glamorous, but there is nothing glamorous about puddles of sweat pooling underneath your chair. Now that my responsibilities have shifted, I don't need to be at the clinic or at Tidziwe every day. However, my days are just as full. I spend my time preparing notes for a class I'm teaching on research methods, meeting with students for extra help or about their research projects, helping the clinic staff write abstracts or make posters, and helping implement a study my advisor is doing in the neighboring HIV treatment center. Oh, and try to write my dissertation whenever I can get a few spare minutes. So, on Friday I went to the Nature Sanctuary Lodge, an oasis of green and calm in the middle of the chaotic Lilongwe dust bowl hoping for some peace and quiet.

It was just me, my cappucino, and nature for a very productive hour and I prepared notes for this weekend's writing workshop (an extension of my research methods course). Sometimes a change of scenery is all I need. A little bit later I ran into two friends and a fourth person joined our caffeinated laptop group. He turned out to be a health economist and the two of us chatted a bit about how I can look at the cost-effectiveness of the two interventions we studied. We have plans to get together next week for a more serious discussion about this - while not part of my dissertation I think it's a really important paper to write because it has direct implications for policy here in Malawi.

This morning at our writing workshop I sat next to the director of the HIV treatment facility that is adjacent to Kamuzu Central Hospital and Tidziwe. We referred a lot of patients to them during the course of our study...over a third of all patients enrolled had HIV that was advanced enough to meet the WHO criteria for starting antiretroviral therapy (CD4 count <200)>at the time of their diagnosis. He and I talked about following up on these patients to see if they actually did access treatment and determining what their clinical outcomes were. I'm really excited to write a protocol to look at this; right now there is a big push for testing in the developing world since the vast majority of those infected have never been tested and therefore don't know their status and can't access treatment, etc. However, the link between increased testing and improved clinical outcomes isn't well established. I'm excited to develop a summer project on this for a visiting medical or graduate student or for a Malawian student!

You never know where your random conversations will lead! I've got a lot of different things going on right now, but I'm also trying to take time to stop and enjoy the mango season. It'll be my last Malawi Mango season for a while....