Planning a trip outside my comfort zone.

I came to Laos with few expectations. Not none, but I really tried to come with an open mind, so that I’d be able to enjoy my time here with lots of surprises - pleasant and odd - but few disappointments. However, if you had asked me before leaving whether I would get involved in helping to organize resident research while I was here, I would have said “No way!” I like research, don’t get me wrong. It guides my practice, and I respect people who are inspired to plan, organize, and complete valuable research projects that add to our collective knowledge base. But I’ve never had the urge to get involved in it before. Sure, I did microbiology research in college - it was fun - there are days when I miss my micropipetter and gels. (Usually these days correlate with some interpersonal relationship/communication issue at work when a patient or colleague is frustrating me, and they have been extremely uncommon since coming to Laos.) But I don’t really miss academic science - the idea of spending my entire career studying a single bacteria, or even a handful of them, just never really grabbed me. And I’m no more a clinical researcher than I am an academic scientist. I don’t think I really have the focus, drive, or organizational skills necessary to make research an integral/important part of my career.

So why am I e-mailing people left and right to help the residents organize a group senior research project? Yes, residents here do research. In fact, they’re required to complete a research project before graduating. This seems pretty crazy. Lots of american residents do research, of course. They tend to be the ones applying for competitive fellowships, and they may take up to 2 months off during residency to work on it. But it’s not a graduation requirement. Our residents get 2 weeks to do theirs. (Really they get a month of vacation/research.)

Unfortunately, they start their class on how to do research in September-October of their 3rd year, and then they’re suppose to write, revise, and have approved a proposal. So most of their actual work takes place in a few months - January-April/May - which limits the amount of valid data they can collect whether they’re doing a cross-sectional survey of behaviors related to a chronic disease or trying to chart review each patient that comes in blood cultures positive for a specific pathogen to find common presentations that should prompt provincial doctors (who don’t have access to cultures) to think of, and treat, that bacteria. This all seems kind of silly to me - but the requirement is theoretically to be sure that residents understand some basic stuff about how good research is done. In a country with very little data about what’s happening here now currently, and where there are lots of people trying to do research who might approach the residents for help once they return to their provincial hospitals, I guess it does make sense for them to have some basic understanding. After all, there is a really good chance they will be asked to participate in research, so it would be good if they had some way to assess whether to do it. But in practice, they are super stressed about finishing their projects, which tend to be small and maybe don’t contribute much to the knowledge base here.

However, this past year, Amy included the pediatrics residents in her Blue book and Oxygen projects, so all the peds residents worked on a component of a bigger project. They still had to understand the same stuff to do and write up their component, but they were able to work together more, with some support from Amy, and the data they gathered will likely be very useful and relevant to Laos. This excellent example is how I came to be e-mailing people about a group project with subcomponents for each of the 3rd year residents this year.

My idea is much less useful than Amy’s project - but it will address a topic I’m interested in - dementia - (Thus the inspiration) and if we can organize it they should come out of it with one useful assessment tool. Chronic disease is under-recognized here as well, so it might generally highlight some neglected topics as well. Now I ‘just’ have to get permission from the university, the medicine teachers, the creator of the test I want to adapt to Lao language and culture, work with the residents to map out a plan, and arrange good support for the residents when I finish work in September. In other words, what have I gotten myself into? We’ll see. . .

Last week at Setta I saw a young woman with fever and pelvic pain. She happened to also be an albino - almost certainly with occulocutaneous albinism, a disease which I only learned about when I searched the literature for “nystagmus albinism.” Her pelvic pain complaint ended up leading to a diagnosis of vaginal candidiasis. Unfortunately, she also had oral candida, and a herpes simplex virus outbreak on her face. And a folliculitis on her neck. And a resolving vasculitic looking rash on her legs. An unpleasant cornucopia of medical problems for a woman so young, and we kept our visiting dermatologist busy for several minutes figuring it all out. She was ‘not married’ but after encouraging my residents to ask again, we determined that she did have risk factors for HIV - she was sexually active. And all of the above problems in a 22 year old sexually active woman are from HIV until proven otherwise. The residents agreed she needed testing, as did the ID doctor when asked Friday afternoon. Unfortunately, the on-call person over the weekend either sent or allowed her to go home, so we’ll never know for sure. Tonight, I’m praying we were wrong.