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The newspaper of The Johns Hopkins University April 18, 2005 | Vol. 34 No. 30
Hopkins Residents in Training for Medical Missionary Work in Africa

The Infectious Disease Institute is affiliated with Johns Hopkins and Makerere University in Kampala, Uganda, where it is based.

Young medical doctors gain experience in treating global infectious diseases

By David March
Johns Hopkins Medicine

Anne Mullally, Scott Kim and Anandi Sheth are all young medical residents at Johns Hopkins interested in treating disease in the developing world, particularly Africa. This month, Mullally interrupts her Baltimore life to follow her colleagues' earlier paths to Uganda as part of a special Johns Hopkins program at the Infectious Disease Institute in Kampala, Uganda. For one month, she will provide direct care to hundreds of HIV/AIDS patients and experience what interests her firsthand. Kim participated in 2003 and Sheth in 2004.

"By offering direct training in Kampala, the Hopkins service gives young physicians a chance to focus their knowledge and skills in treating infectious diseases in Africa, primarily HIV," said Thomas Quinn, a professor of medicine and international health and deputy director of the Division of Infectious Diseases at the School of Medicine. Quinn started the program in October 2003 with private funding. "This work experience is designed to foster careers that make a measurable difference in the field of global health."

While in Uganda, Mullally will work three days a week at the Infectious Disease Institute, which opened in October 2004 as a specialized AIDS treatment center and is affiliated with both Johns Hopkins and Kampala's Makerere University School of Medicine. Until her return to Baltimore on May 12, she will care for 10 to 15 patients per day, some of the 200 or more patients who line up each weekday morning at the center. Uganda has more than 1 million people living with HIV, many on complex antiretroviral therapy that prevents the virus from replicating; they also have high rates of AIDS-related tuberculosis and cancer.

With the rest of her time, Mullally will work in the center's cancer clinic, focusing on treatment and research on HIV-related cancers, such as Kaposi's sarcoma and Burkitt's lymphoma.

"This is my first opportunity to have a firsthand look in Africa at HIV, the major epidemic of our lifetime," said Mullally, a third-year internal medicine resident who came to Johns Hopkins after completing medical school in her native Ireland. "I expect it to be an eye-opening experience where I'll learn how to stretch resources to meet the great demands for medical care."

Scott Kim, from Silver Spring, Md., was the first Johns Hopkins resident to participate in the program, as a 27-year-old in his second year of medical residency. Kim said he was surprised by the logistical challenges of providing effective antiretroviral therapy in a developing nation. "Delays in getting medical supplies were issues as important to providing care as obtaining the necessary funds to purchase medications," he recalled.

"In Africa, when you plan care or research activities for people living with AIDS, you cannot simply purchase your medications and deliver them as you would in North America," Kim said. "Even in the well-populated urban areas, you must be prepared to deal with the lack of basic infrastructure, which can cause critical treatment interruptions. Many patients appeared to suffer from emerging viral resistance due to three-to-four-week interruptions in their antiretroviral therapy. Basic survival for these patients hinges on a consistent supply of medicines from international aid organizations," he said. "These issues are compounded by financial concerns; I met patients who had sold their cars, houses and cattle in order to meet their monthly medical expenses."

Anandi Sheth spent time at the IDI as a 27-year-old, second-year medical resident. "I saw firsthand how much could be accomplished with limited resources, even with thousands of families affected by the disease," said Sheth, who comes from Little Rock, Ark., and attended medical school at Johns Hopkins. "There were a large number of charitable organizations, including Hopkins, providing staff and resources to help treat people. The local staff was very knowledgeable and well trained about HIV care, even if they did not have ready access to the latest research. More importantly, people were highly motivated to participate in their treatment. Adherence rates for properly taking medication were very high, better than 90 percent," she added.

"Ugandans will be living with HIV/AIDS and antiretroviral therapy for many years to come," Sheth noted, "and their illness will have to be monitored for drug resistance, as well for the long-term social and psychological effects resulting from thousands of children orphaned by the illness. The experience solidified my initial decision to work on preventing the spread of HIV in Africa, where there is a lot of potential to make a difference."

Said Kim, "It was the best month of my entire residency experience — it gave me a pretty good feel for how I could meaningfully work in the region. I gained an appreciation for the cultural isolation and stigmatization associated with the disease, and I saw how damaging HIV could be as a social diagnosis. Through the experience, I rediscovered my motivation for future work on AIDS."


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