2011 Grant Recipient 
South Africa
MHS Program, Department of International Health, JHSPH
We are seeking a graduate student to spend at least 4 months of research internship on the above referenced research project at the Faculty of Health Sciences/Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa. Student will be exposed at unique rural and urban patient recruiting sites. In addition, the modern infrastructure and sophisticated research facilities at the urban site located in Cape Town, combined with interaction with underserved peri-urban townships and rural communities (Ukwanda Rural Health School), affected by a wide range of diseases - but mainly HIV/AIDS and related opportunistic infections such as Tuberculosis.
Personal Narrative:
Living in Cape Town was a wonderful experience. It had all of the excitement of being in a developing country along with a lot of the comforts of home. The city was beautiful, the population was very diverse, the weather was perfect and I lived between the mountains and the ocean. It doesn’t get much better than that. Besides the beauty, the most striking characteristic is the dramatic inequality. One minute you are sipping rooibos at a café in Green Point and 20 minutes later you are driving through Khayelitsha, the biggest township in South Africa. The scars of apartheid are still visible and many people, of all races, are not ready to forgive and forget. The government is taking steps to shrink the gap, but progress is slow. Although my work took place at a teaching hospital almost 20 years after the end of apartheid, residual effects were still evident in my work. Stellenbosch is historically an Afrikaans university and was basically a ‘whites-‐only’ treatment center. Since HIV-‐Associated Nephropathy (HIVAN) is typically seen in people of West African descent, this limited our retrospective study data. Interestingly, the new laws passed to protect patients from discrimination based on race also interfered with data collection. Physicians are no longer allowed to capture race in the patient folders, meaning that in our analysis race had to be inferred based on the language spoken at home. The main lesson I learned in regards to research in developing countries is to steer clear of retrospective studies. Information collected on patients is not uniform and in my case written in several different languages within the same chart. Vital information, such as the CD4 count for an HIV positive patient, was missing around 40% of the time and follow-‐up is next to impossible. Once a patient leaves the hospital with an HIVAN diagnosis they typically attend a smaller clinic for the duration of their treatment. The health system is not strong enough, especially in rural areas, to allow for proper follow-‐up in these situations. This makes outcome assessment a real struggle. Despite all of the limitations to the research environment I still intend to pursue a research career in a developing country setting. I am perhaps even more dedicated to the goal after going through all of the rough times. Obviously the need for capacity building is present, which is one avenue that I may want to travel down. Meanwhile, the issue of inequality specific to HIV infection in countries like South Africa has become a passion of mine. However, because of the difficulties I would recommend this type of experience to anyone interested in working in international health. It is not always easy, but it is most definitely an adventure. |
