Work at Tenwek
Dr. White and I met the day after we arrived at Tenwek (on a Saturday) and had a great meeting about plans. He left just a few days later for the States and just recently returned after his three-week trip. But, in the meantime I have a much clearer picture about duties, responsibilities, and expectations.
Clinical Duties
During usual circumstances my duty is to report to the endoscopy suite each weekday and perform all of the routine endoscopies. This includes many cases of esophageal cancer a day and the dilation/stenting that goes along with it (see this link and this link about stenting). In 18 days of doing endoscopy (pretty much unsupervised), I have seen 18 cases of esophageal cancer. That's over four times as many as our entire hospital in Lubbock averages in a year. The average age: 54. I've listed the ages just so that you can see how this disease spans an entire lifetime:
16, 24, 35, 36, 38, 43, 45, 51, 55, 60, 60, 61, 64, 69, 76, 77, 78, 80
On Monday I sat with a 24-year-old. I was angry. I shouldn't have to tell a 24-year-old he's going to die soon of cancer.
So far I have done more upper endoscopies than I did all of last year. The guys there are great to work with. Robert is the head nurse, David and Ruben are the other two nurses. Stanley Tonui ("ST") also pops his head in from time to time (more about him later). Robert and David have worked for Dr. White for almost a decade, so they know more than I do in some ways!
I'm also covering surgical cases when I have time or a specific interest. Call is approximately every third or every fourth night. It's home call, and I usually have at least three hours in bed (maybe answering questions from the intern though). I have operated most call nights though at least once. Weekends are interesting because you take both Saturday and Sunday! But, since you are able to go home (in theory) and things are not quite as busy, it's tolerable. Not possible at home, that's for sure!
The other part of my clinical duties is covering when a resident goes on leave or has a day off. Then I help by rounding on the patients, coordinating the wards, etc. I'm basically the chief resident on the service.
Other Schedule Stuff
Like at home we have an educational conference and M&M (though it's quite different). Our educational conference is every Tuesday at 7 a.m., and we take a test and review a chapter in Schwartz, one of the two authoritative surgical texts.
Research
Well, this is primary academic reason I'm here. So, there are some exciting projects that I'll be working on here:
- Case Control Study: In a nutshell, a case control study takes people with a disease and compares them with people without the disease and looks for risk factors. To improve its accuracy, the two groups are often matched for age, gender, tribe, et cetera. We are going to look at a host of factors including diet, living conditions, herbal medication use, disease exposure, and genetics. We aren't expecting a breakthrough as much as a tiny foothold to start climbing our way up! If we can at least know to screen all those over thirty with specific risk factors, that's a great start.
- Follow-up: We have a huge registry of those who have been stented, have been previously screened, and those under the age of 25. So, we have Stanley, our Community Cancer Coordinator (who I mentioned above) out on his piki-piki (motorcycle) going to the different villages and finding these folk and doing follow-up. Stanley ("S.T.") has been a longtime worker in Community Health, so he really knows all the little villages well and how to find people. Already Dr. White's preparing to publish his series of 1,000 stents. That's more than most institutions in the world, let alone one individual.
- Database: Yup, this is where my strengths in computers come in. We have year's worth of patient records that we've kept on every patient that's come through endoscopy. Bob, my predecessor, got it caught up to January 2008. The problem is that it's in Excel, not a very user-friendly way to enter data. In particular it doesn't do much to prevent data entry folk (who typically don't know what data are supposed to go where and why) from entering mistakes and misspellings. By creating a database using Microsoft Access I can create parameters and warnings so that our data are already screened and standardized before I go through it. (Example, in one database the same province was entered as Rift Valley, riftvalley, RiftValley, rift valley, RV, etc. Computers like consistency).
- New Endoscopy Equipment: We're getting new endoscopy equipment soon that has ben donated by Fujion. And, we should also be able to set up a computer to do the standardized reports like you may have seen with a colonoscopy (pictures and all). Right now we just have hand written reports. The thought of having a searchable PDF database with all of our reports is exciting.
- Cryotherapy: For the (unfortunately rare) patient with just dysplasia (very early cancer), we can remove just the lining of the esophagus. One way is by freezing it off! A company in Baltimore that is owned and run by Christians has donated a machine for us to use in a clinical trial (See link). So far we only have one of the thirty-seven patients needed, but we're working on that. We have several people recently identified with dysplasia that should be candidates if they're willing to participate. It should be an interesting trial.
That's only the tip of the iceberg, which is exciting for me. I feel like there are many projects that I will be involved in this year. Dr. White is an inspiring, visionary individual. In many ways he reminds me of when I worked for Dr. O'Keefe.
So, my job is essentially to coordinate and carry out the sundry projects that Dr. White has going on. Though I knew esophageal cancer was prevalent here, I have had many days I have quite literally sat down, sighed, and just wondered if I was really witnessing all of this disease. It's stunning. And thus esophageal cancer has been transformed in my mind from something that I think needs to be investigated to something I feel really passionate about. It only takes looking one 24-year-old (or 30-something year old) in the eyes and telling them they're going to die of cancer to be motivated!