New Beginnings, New Challenges

Well, it seems that my goal of publishing at least once a week has already fizzled. I guess I could blame it on the following:

1. No internet for 3 straight days, even at the great expense of the NIH


2. 3 days of figuring out how to format my fucking blog the right way


3. moving into a new house with only dial-up connection, on which I have limited access anyway


4. and just plain laziness


5. All of the above

No, really, a lot has happened that I want to tell you about, and I will seriously try to update at least once a week, if not more (Haa-haaah in voice of The Bully from the Simpsons)

So, as the description that accompanies my GQ/Abercrombie photo at right states, I am here officially as a National Institutes of Health Fogarty/Ellison Overseas Fellow in Clinical Research. The real title should be NIH Fogarty Fellow, which is what I tell people, but that is an issue we are currently working out with the leaders of the program, to let the Fogarty name stand for itself like the Rhodes Scholar or Fullbright Scholar does, etc., etc., blah, blah, blah, but that is a topic for a different day. So, the NIH is the government institute that pretty much sponsors and oversees most of the major research that is occurring throughout the US and internationally. There are 27 Centers at the NIH (National Cancer Institute, National Instiute for Allergy and Infectious Disease, National Heart, Lung, and Blood Institute to name a few). Well, the main center that handles all International research is the Fogarty International Center (FIC). For those of you dying to get more info, here is the FIC website (www.fic.nih.gov). So, the bigwigs there realized that there really were few programs geared toward international research for young scientists. The FIC fulfilled that need by establishing this fellowship, predominately for medical students, but also for PhD candidates as well. It is in its 2nd year, and sponsors 27 fellows in 18 countries. For a more information and complete list of countries involved, please see www.aamc.org/students/medstudents/overseasfellowship/start.htm.

This past year there were 125 applicants, of whom they interviewed 50, and chose 30 from those. To be honest, I have ABSOLUTELY NO idea how or why they chose me. That is something that is of constant debate amongst my family and friends. Whatever the case maybe, I am here working with the Center for Vaccine Development at the University of Maryland-Baltimore (CVD-Maryland) under the tutelage of Dr. Chris Plowe, and the Malaria Research Training Center, University of Bamako, Faculty of Medicine, Pharmacy, and Dentisty, under the direction of Dr. Ogobara Doumbo. My main work will be with the Malaria vaccine trials currently under way here. I say trials because Mali has 2 different vaccine trials occurring with 2 different groups: one sponsored by the NIH’s own Vaccine Development Branch in Doneguebougou, a hamlet about 30 minutes from Bamako, and the other sponsored by my mentors from the CVD-Maryland in Bandiagara, a small village in the Dogon region, about 720 km away from Bamako. My role is not entirely clear at this point, but based upon what last year’s fellow did I will be one of the study clinicians in each of the trials (Insert Big Gulping sound here). That means that I will be involved in performing clinical assessments of patients enrolled in the trials, performing blood smears to assess for Malaria parasites and performing analysis of blood samples to assess for proper responses to the vaccine, providing health care for all non-vaccine related issues to participants families, and learning about providing good quality health care in settings that lack the many of the amenities that we take for granted. It sounds like a rather daunting task, and it is, but I am definitely up to the challenge. I have been looking for something like this for my entire life, and I am now living the dream so to speak.

(Aside: There is a problem with the above scenario: I kind of came on board right at the tale end of both vaccine trials; the Bandiagara trial ends in 6 weeks, Doneguebougou ends late Nov. Luckily there is another trial that is supposed to begin starting in Bandiagara in the Spring barring no unforeseen problems. But this is Africa, and this is clinical research, so something (or someone) always changes the plan at the last minute. My one saving grace is that I will spend at least the last 3 months of the Doneguebougou trial to get a sense of what this crazy vaccine world is like, so I have that going for me which is nice. Bandiagara is a whole other issue, and I will keep you updated about that periodically. . . )

So you may be saying to yourself: “Well, he is getting all of this clinical background and stuff. How does that relate to clinical research?” Good question. Working on the vaccine trial by proxy affords me the opportunity to see the development and implementation of the protocol (i.e. script that dictates how each participant will be randomized, what clinical measurements need to be measured, how they will receive the vaccine, what specific days the participants need to return to the clinic for follow-up, etc. Some of these protocols are hundreds of pages long. I am supposed to receive the Doneguebougou protocol soon, so that should make for some light reading. . . ), working closely with the village elders and committees that ensure patient rights and confidentialty, internal analysis of data to ensure patient safety, and thousands of other tasks which I haven’t learned about yet.

I will also gain said clinical research experience by designing and implementing my own study. From the get go, I wanted to have something to call my own, something that I can walk out of here with and say “This was how I spent my National Lampoon’s African Vacation!! (Hmmm, I smell sequel people. . .) Luckily I have a background in epidemiology (well, what that really means is that I took some courses in grad school in something that resembled epidemiology to qualify for a MPH and “worked” for a couple of years as an “epidemiologist” [note the “quotations” here people]) to help me out. I have a couple of ideas floating around, and the next few weeks should help me iron out those issues.

So now that we have the boring stuff out of the way, just what have I been doing the past 2 and a half weeks you might ask:

• Working in the Parasite Diagnosis lab learning techniques to diagnose Malaria (i.e. thick smear/thin smear, staining, and identification)


• Attending rounds with the Heme/Onc service 2x per week


• Met with the principles of each unit here at the MRTC to discuss possible studies that I could accomplish during my brief journee here.


• Getting accustomed to Mali

As for that getting accustomed thing, I moved into one of the study houses “aka villas” in the heat of the capital, the Garden District of Bamako if you will. It will serve as my home base while I am not living and working in the field, either on the vaccine trials or on my own self-designed project. Perhaps the coolest thing about my new house is it is within walking distance to the coolest restaurants, bars and nightclubs in the city. I have had dinner out in that area every night this week and I can honestly say that it is not that bad. Since I do not have access to a driver after 6:00, I walk every where. Now, for the unititiated, the walk would seem daunting: next to no streetlights; many, many mud piles; garbage and raw sewage in the street; BMWs parked next to trash heaps and shanties; security guards everywhere guarding their respective houses; feral dogs running wild; toads that croak incessantly, and in my opinion are saying “Shittt,” “Shittt,” “Shittt”; and thousands of other little things that make it so unique. Now, normally in any other city in the world I would be scared shitless and insist on driving. But for the most part, I feel very safe, and I have made friends with the security guards along the route. Luckily I had some initiation to this sort of living on the wild side in New Orleans!!

For any of you who have lived overseas, especially the Peace Corps folk, people who can afford a house also find ways to afford drivers, gardeners, security, and nannys for their children. Well, no children yet, but there are the other 3 acoutrements at my house. The drivers are cool, and speak absolutely no English, except for the old standby Malian-attempt-at-English phrase: “Hello, How are you? I am fine. You are nice.” My house is nice, BUUTTTT: the only downside is that it is an office during the day. The CVD-Maryland owns the house and uses it as their HQ. Thus whenever the study doctors are here in Bamako, they work there. Whenever my boss, Chris Plowe, comes in with his team from Maryland, they work and stay there. It has taken some getting used to, and there are some subtle housemate issues that are slowly getting worked out, but nonetheless it is home and I am content. I have a couple of ideas about pimping out my room in the back, once the leak in the window and wall is fixed. There is also an unused patio in back that has a lot of potential, so that will also become part of the Chez Craiger.

Well, that is about it. Expect more in future posts rather soon. And I am still working out the issues with the picture sharing capacity with this new program, so bear with me.

Love Life, Enjoy Liberty, and Be Happy,

Craiger