A light in the darkness
The Johnson Opportunity Grant is a fund awarded on a competitive basis that aids W&L students’ projects. As a recipient, I want to thank the faculties, sponsors, and administrations at Washington and Lee University for making my remote research in South Africa possible, especially during the COVID-19 epidemic.
Winter 2020, I began my application to intern in South Africa through the W&L Cape Town Program, and I couldn’t sleep from excitement when I received my acceptance into the program. I knew that interning in South Africa was the only thing that I wanted to do this summer. When school was canceled due to the epidemic, my dream and hope were shattered overnight. My summer plan fell apart. I was so close to losing all hope, however, the Johnson Opportunity Grant made it possible for me to do remote research in South Africa through CONNECT123 virtual program. Through the program, I conducted a research under the guidance of Dr. Liesl Zuhlke and her team at the University of Cape Town and Red Cross Children’s Hospital, Children’s Heart Disease Research Unit. Under the guidance of Dr. Zuhlke, I learned about the health care system in South Africa for treating children with congenital heart disease (CHD) and rheumatic heart disease (RHD), how to concisely condense information, and work in a virtual remote environment. This research position opened my horizon and connected me with many other likeminded researchers and doctors across Africa.
When: Summer 2020
Duration: 6 weeks
Where: Red Cross Children’s Hospital- Children’s Heart Disease Research Unit
Work: My summary of RHD and CHD is under the More about the research section. Due to legal and privacy law, I cannot post unpublished data online.
More about the research
Principle Investigator
Dr. Liesl Zühlke is currently a Pediatric Cardiologist at the Red Cross War Memorial Children’s Hospital in South Africa and an Associated Professor in the Department of Pediatrics at the University of Cape Town1. She has received many rewards for her research on heart diseases. Dr. Zühlke is a leader in her field, specializing in rheumatic heart disease (RHD) and congenital heart disease (CHD) on the African continent and internationally. With others, Dr. Zühlke and Jonathan Carapetis create RhEACH, a project that aims to change policies and amplifies RHD control, and the team has grown in numbers since its start in 2013. Her current research focuses on epidemiology and outcomes of RHD and CHD on the population in the African continent.
RHD
RHD is a preventable condition that result when one’s immune system catastrophically response to a bacterial infection caused by Group A Streptococcus (GAS)3. Following the infection, acute rheumatic fever (ARF) can progress repetitively, producing an immune respond that attacks other organs. In a recent paper, approximately 33 million people are living with RHD globally, and the condition accounts for about 350,000 deaths per year. More shockingly, the majority of these deaths, more than 80%, locates in the low-income countries of sub-Saharan Africa (SSA)2. One of the major barriers for treating RHD is the lack of African health workforce3. For example, SSA carries 24% of the global disease population while only having 3% of the global workforce. On the other hand, Americans carries 10% of the global disease population but is home to 37% of the global workforce, exemplifying a sharp contrast between the two populations. In order to fix this gap, Forcillo et al. suggests that mentorship programs and collaborations are necessary for cardiac surgery training in SSA4. In addition, a heart center that centers around a multidisciplinary and team-orientated environment will serve the public with more success.
CHD
CHD is a condition which as infant is born with an abnormal heart structural or great vessel, affecting millions of newborns each year5. Moreover, it is one of the most common birth defects globally, leading to more deaths than all childhood cancers combined2. Previously, the prevalance of CHD in children birth in SSA is thought to be similar other parts of the world, estimating to be 8 per 1000 live birth3,5. However, the number of CHD affected individuals in Africa may be underestimated due to limited antenatal screening before birth, backing up by recent data from many African countries. In Sudan, the prevalence of CHD in adults and children are significantly higher. In Cameroon, 13.1% of patients were diagnosed with CHD in a 4-year study period. Not only in these countries, similar trend can be seen in Mozambique and Nigeria. In conclusion, advocacy at the policy and government level is needed to take step in the right direction to minimize the gap difference5.
Achievements
From my remote internship, I achieve my personal goal of continuing my pursuit of wisdom and breaking free from the W&L bubble, and I will take what I have learned and apply them medical school. My experience allows me to break from my traditional W&L bubble to challenge myself working in a remote, virtual environment. After the Cape Town Summer Internship Program, I have gained new perspectives that diversify my ideas and understanding of the world. One of the things I notice while working virtually is that cultures facilitate different work ethnic and teamwork. For example, honorific in South Africa is less important than in the United States. I call my PI by her first name at her request. In addition, South Africa has more a community-based work ethnic where people help each other out. I find it interesting that during online meetings, the team is flexible with social hours and catches up with each other instead of going straight to the meetings’ objectives. Taking back what I learned from the program helps me to expand my W&L bubble and achieves my goal that aligned with W&L’s mission of life-long learning, responsible leadership, and engaged citizenship in a global and diverse society.
Aspirations
An integral part of this experience is doing what I love, working in the medical field, to improve people’s health. Being a doctor has always been a dream of mine since I was little. I am excited to work with medical professionals to aid others and to improve their lives. A part of my research is to build upon a past survey by broadening it out to pediatric cardiology surgeons across the African continent and investigating the current infrastructures available for patients to get access to cardiac surgery. I get to work with my PI to connect with many doctors from Uganda, South Africa, Nigeria, and many more. My objective as an intern is to conduct, promote, and support children’s heart research in Africa. These data will allow better funding to areas that need more than others. According to previous research, many countries in Africa are not equipment with the required equipment and facilities to treat and perform surgeries for RHD and CHD patients. This research experience has strengthened my future aspiration to travel to poor communities to provide medical assistance to those without or limited medical access. Now, I am more inspired to become a doctor.
Challenges
As everyone is aware, transitioning to working at home is difficult and comes with many challenges. One of the struggles that I faced was working with different time zones. There was a nine hours difference between Pacific Time Zone (where I located) and African Standard Time Zone in Cape Town, South Africa. I had to wake up at 5am in the morning some days for meetings. Thus, communication was a tall wall to jump over. In addition, another barrier I faced was finding the best way to work at home with many distractions. I came up with the following solutions. For the first problem, I set a schedule that allowed me to get enough sleep to wake up early for the meetings. I made it into a habit to sleep early, so I could feel refresh the next morning. This was the easy part. The second problem was much harder to overcome; I often found myself looking at my phone often and got distracted easily. To fix this, I turned off my phone and put it far away from where I worked. Afterward, I reserved small area near my bedroom window to work with plenty of sunlight. In addition, I enforced a rule on myself that I could not look at my phone during break. Moreover, I couldn’t do any fun activities before I finished my daily goals that I wrote down every morning. Doing a combination of all these rules made me a better worker while working at home. I learned many things about myself and skills that I can take with me in the future. Every transition is hard, but for me it is not impossible. From this wonderful experience, I am super glad that I have acquired many skills that I can take with me in the future.
- Children’s Heart Disease Research Unit. (2016). Conduct and Support Children’s Heart Rearch on the African Continent. Retrieved from http://www.chdru.uct.ac.za/sites/default/files/image_tool/images/476/CHDRU%202016%20Annual%20Report_0.pdf
- Zühlke, L., Sliwa, K., Naidoo, P. et al. Cardiovascular medicine and research in sub-Saharan Africa: challenges and opportunities. Nat Rev Cardiol 16, 642–644 (2019). https://doi.org/10.1038/s41569-019-0269-z
- Zühlke L, Mirabel M, Marijon E. Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities. Heart 2013;99:1554-1561.
- Forcillo J, Watkins DA, Brooks A, et al. Making cardiac surgery feasible in African countries: Experience from Namibia, Uganda, and Zambia. J Thorac Cardiovasc Surg. 2019;158(5):1384-1393. doi:10.1016/j.jtcvs.2019.01.054
- Liu Y, Chen S, Zühlke L, et al. Global birth prevalence of congenital heart defects 1970-2017: updated systematic review and meta-analysis of 260 studies. Int J Epidemiol. 2019;48(2):455-463. doi:10.1093/ije/dyz009
- Zühlke, L. (2018). MRC/DFID African Research Leaders Feb 2018 Population & Systems Medicine Board Cardiovascular. Retrieved from Liesl Zühlke