La Entrada

17 11 2010

By Kristen Roehl

Hello Global Health aficionados, and thank you for having me. Despite the reality of having been in Peru for two weeks, this is my first time writing on the communal blog.  I can blame technical difficulty or mental disconnect or both… but I am now here and excited to be a part of the weekly digest I’ve been receiving since early May! My name is Kristen Roehl and I am a member of the first cohort of MScGH students at the Duke Global Health Institute. My interests lie primarily in reproductive/obstetric health, family planning, gender-based disparities in health, traditional approaches to medicine, and Latin American cultures. After a series of challenges coordinating my fieldwork, I am finally here. Let us begin!

Before recounting any details of Lima, Peruvian culture, global health issues, etc, allow me to give you a brief synopsis of my project down here.  I am working on the final phase of a two-year study that is part of el Proyecto Cisne, funded by the World Health Organization, and carried out by researchers at la Universidad Peruana Cayetano Heredia (UCPH). This study aims to examine the multiple dimensions of implementing rapid tests for syphilis (RTS, or PRS in the Spanish acronym) in and around Lima, Peru.  PRS is a rapid treponemal test, which means that it assesses a patient’s  positive or negative status in 20 minutes and allows for immediate penicillin treatment at the point of care, as compared to the laboratory gold standard of RPR+TPPA, which has a turn-around of days in real-world clinical practice.

The downside of treponemal testing is that it detects any syphilis infection- both current and past/treated- so it is better reserved for populations that have relatively low incidence rates but high consequences for true positivity. This study therefore works with pregnant women, who may suffer a range of pregnancy complications due to syphilis, or who may pass on congenital syphilis to their infants. The study population is pregnant women receiving antenatal care, delivery/postpartum services, emergency services, or hospitalization for complicated pregnancies in two health networks:

 

1) el Instituto Nacional Materno Perinatal (INMP), the largest and most comprehensive of all maternity care centers in Peru. Located in a central neighborhood of Lima called La Victoria, where I’ve been told many times not to stray alone, INMP or la Maternidad handles most cases of complicated pregnancies in the city and its surrounding areas. Some patients come from as far as 8 hours away to give birth at la Maternidad, as it is one of the only hospitals equipped with necessary specialists and equipment to handle pregnancies of the highest risk. I have visited la Maternidad twice already, and it surely lives up to its reputation as a hustle-and-bustle hospital.  Not only does it offer every service imaginable for pregnant women, but it also has a separate center for adolescent pregnancies, comprising about 15% of total patients. Women wait, then move to another station, then wait, then move to another station, then wait, etc. for about 3 hours in each prenatal care visit.  The waiting halls are packed, particularly in the mornings, with two or three generations of women sitting together a much more common sight than the fathers-to-be. Despite the hectic nature of the place, however, the health staff and the patients are kind and inviting, and very willing to help a traveling student learn. On my second visit, the midwives in the antenatal care unit let me observe about 20 rapid tests being done, and even taught me how to do one myself. No, I did not practice on a patient.

2) Ventanilla, a municipality in the district of Callao, about an hour outside the population-hub of Lima. If la Maternidad appeared to the ne’er traveled like a poorly maintained County hospital in the U.S., then the sprawling homes of Ventanilla would appear like slums and shantytowns seen in pictures from around the world. The comparisons are shallow, but not without merit. Ventanilla stretches as far as the eye can see, nestled and scattered among dune-like hills north of the nation’s capital. The only buildings constructed of solid walls are the clinics and the churches, dogs run rampantly through the streets, and pregnant women live in one of every four to five houses. This study has gathered data from 16 health centers in the Ventanilla network. Like at la Maternidad, each patient coming for pregnancy care receives the finger prick.

My role in this study, apart from participating in as many site visits and data collection exercises as I can, is to assess the diagnostic accuracy of these rapid tests as compared to the laboratory gold standard. Sensitivity, specificity, positive/negative predictive value, influencing factors, etc. In two weeks, I have managed to:

  • Visit la Maternidad twice, observing the different departments, being versed on the field procedures for health providers gathering the data, meeting all the health providers involved (mostly nurses and midwives), and learning how to do a rapid test
  • Accompany a biologist and field researcher to the sites in Ventanilla to collect stored serum samples for the reproduction of the three tests (PRS, RPR, and TPPA) in the laboratory
  • Observe all laboratory tests being done
  • Assess the overall diagnostic qualities of the most-recently-updated datasets (including merging, cleaning, and manipulating data using STATA)
  • Generate a list of all facets that I hope to explore in order to write my thesis
  • Explore Lima and plug into the expat student network
  • Take private nighttime Spanish classes a few times per week, which generally consist of my being frustrated with just how much I’ve forgotten due to 5 years of disuse… but are always challenging and informative

Not bad for two weeks in.  There is so much more I could say, but this first post is long enough already. I’ll leave you for now and release smaller tales from here on out. If you want to hear about anything specific, please let me know! Para ahora…

Saludos,

Kristen

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