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."