20 March 2006

Match Day 2006

Match Day was March 16, ironically the same day that we started vaccinating. Match Day can best be described as either the best or worst day of your medical career. Today, all the 4th year medical students around the country find out where they will be completing their residency training. For all of my former classmates at Tulane, it is day that none of us thought would ever arrive. It is the culmination of 3 and a half years of hard work and sacrifice. For many, they will get one of their top 3 choices for residency training; for some, they will be training somewhere they never thought they would be training.

The Match works like this: 4th year medical students select their specialty and apply to a central Residency Application service that processes all of the applications. If the program they are interested in is likewise interested in the candidate, the student is invited for a day long visit to the hospital and an interview. After all interviews have taken place, the student ranks the programs he would consider training at from highest to lowest. The residency programs likewise rank the candidates highest to lowest. A computer analyzes all of the data from all of the students and programs and creates a Match list. A Match occurs when a program on the student’s list is matched with the student’s name on the program’s list of desired candidates. The Match is set up so that the student is given preference over the programs. I do not think I did the program justice here by attempting to describe the process; needless to say it is a complicated process, and a dreaded one, but all medical student entering residencies have to go through it.

As I was in the village when the Match happened, I did not find out the results until Saturday afternoon. I was visibily shaking when I went to the Tulane Med website, and read the list. I was so excited and surprised at the results. My classmates did very well, thank God.

I just wish I could have been there for the party and the celebration. I have attended the Match celebration in New Orleans a few times, and it truly is a huge party. And given this year's circumstances, many thought there would be no medical school at all, let alone a match. Were it not for the dedication and devotion of our deans, Drs. Krane and Kahn, none of this would have happened. Congratulations to all of my former classmates on their respective matches!!

The vaccination team. You might not recognize the lone white guy in the picture.  Posted by Picasa

A hard earned lunch after a long morning.  Posted by Picasa

The ever challenging process of taking blood from a toddler. Very, very tough job, as you can see here. Posted by Picasa

Identifying patients for screening. That is Kimate in the back making sure this child was who he was supposed to be. Posted by Picasa

17 March 2006

Vaccination day!!

After months and months and months of waiting, we finally had our first day of vaccination!! It went as I expected it: a little disorganized, getting things done last minute, and anti-climactic. I had been waiting for this day for so long that when it actually came and was over, it seemed like nothing at all. But it was still incredible!!!

We invited 21 of our screened patients who satisfied all of our requirements for inclusion and exclusion into our trial, of whom 18 would actually get vaccinated. My role that day was one part clinician (assisting the Malian doctors with the clinical assessment) and 5 parts logistics man, mainly the cameraman. Part of the confusion that resulted the day before dealt with the camera. The study site camera stopped working, so I volunteered the use of my digital camera to take the participant’s photos. The plan was to hand off the camera to the researchers in charge of clarifying identification, but for some reason it would not work for them. So, I was given the task of photographer for the day. It was fun taking pictures of the kids we would vaccinate. The hardest part there was trying to get them to smile. There is not the same photo-crazed climate as in the US, so every single child had the look of sheer unhappiness on their face, despite Zanble’s efforts. Away from the camera, I assisted the Malian staff with the clinical evaluations pre and post vaccine.

We were able to vaccinate our desired number of participants, some of which would receive the malaria vaccine, and others of which would receive the active control vaccine, Hiberix (which protects against a bacteria called Haemophilus influenza, one of the leading causes of strep throat, ear infections, and more seriously, pheumonia and meningitis, in children). True to most drug/vaccine clinical trial, none of us knew who received what. This allows us to evaluate everyone without prejudice to what they received.

From here on out, the work is mostly follow-up. Each participant must return to the clinic on a set schedule for a clinical evaluation and occassionally lab work to make sure the vaccine has not affected their health in ways that cannot be measured by signs and symptoms alone. About a month after their first vaccination, they will receive a second vaccination. The purpose of this 2nd vaccination is to boost their immune system response to the particular protein on the malaria parasite that our vaccine is targeting. After that 2nd vaccination, they will continue to return to the clinic periodically for clinical evaluation and lab work for the following year.

Perhaps the most important part of the follow-up will happen when my fellowship period is over. In addition to their regular clinic days, we will be also be periodically evaluating their malaria status during the intense transmission season here (mainly August - November) to determine if they are adequatelyprotected or not. Sometimes, people can be infected with malaria, but not show symptoms of disease. We hope to see if this is this occurring in these patients. We also expect the participants to come to the clinic at any time for any complaints or illnesses that come up, as part of their compensation is complimentary medical care during the course of the study.

Lastly, I feel it is important to clear up one imporant point. I think people need to realize that we are just getting started with our understanding of the immunology of malaria and in the vaccine development process, and we have a long way to go before we have a marketable malaria vaccine. There are many, many issues that need to be addressed (i.e. type of vaccine target, falciparum vaccine only vs. vaccine for other types of malaria, genetic diversity of malaria, target population (kids vs. travelers), etc.) before we can say we have an adequate vaccine.

10 March 2006

No, that is not the moon. The dust from the Sahara even blocked out the sun. Posted by Picasa

View of said dusty/fogginess from our front porch on our compound. Posted by Picasa

Foggy Bottom

Headed back to Bamako for the weekend for a little R&R and to get my life in order. Sunday will mark the 2 month countdown to the day when I leave Mali, 12 May 2006 at 11:55 pm on Air France. Hmmm, is someone ready to leave???? Honestly, it has more to do with being ready to start the rest of my life (aka the rat race that is 4th year medical school, loans, and that little thing of what the hell to do with the rest of my life) than wanting to leave Mali. I keep wondering if and when I will come back here and in what capacity. Again, answers to questions like that are impossible to predict, and if it was meant to happen it will happen.

In other news, I woke up on Wednesday morning, and it was very, very foggy outside. Seeing as we are in the dry season, fog should not be hitting us right now. When I walked outside, I could barely see 5 feet in front of me, and I started coughing non-stop. I then realized what was happening. There are 2 main winds that accompany the dry season. The first happens right at the end of the rainy season, and is called the Alize. It comes from the south, the Atlantic, and blows cool, dry air North. Around January or so, the wind changes direction, and the Hamartan blows hot, dry air from the Sahara Desert South. Occasionally, there are huge sandstorms that accumulate massive amounts of sand, and the sand is carried in the atmosphere South. This manifests itself as a extremely dusty, fog-like cloud that hinders visibility, causes massive eye and respiratory problems, and lingers for sometime weeks. Well, this is exactly what happened Wednesday. I am not sure when visibility will return and my cough will go away, hopefully soon.

08 March 2006

International Women's Day

One of the lasting memories I will have of Mali is the seemingly strength of the women here. With out a doubt they work 2 times as hard as the men do: collecting water, cooking, taking care of the children, selling goods at the market, and even working in the fields. All the while they have a constant smile on their face, laughing and joking around with other women.

So I thought it was fitting that they celebrated International Women's Day with a grand conference and party. President Amadou Toumani Toure attended the event along with other dignitaries at the Palais du Congres in downtown Bamako. A unusually light day at the clinic (10 patients all morning) and nothing else to do after 10 am allowed us to watch the proceedings on TV (the one “luxury” we have in the village, despite the fact that it is only 1 channel, the government run ORTM). Some of the great singers of Mali came on and performed, skits were performed in the local language, Bambara, and the biggest thing, the president spoke. He gave his usual address, marking the great strides Mali has made in women’s rights, and made some blank promises to improve their lives even better.

The one theme that is common not only to this one day of speeches and mild celebration but to most of the functionaries (i.e. government workers) and politicians in general here is “empty promises.” They always promise to do better, to do good for this one particular group they are speaking at or attended a meeting at, and in the long run, nothing will really change. Even some of my Malian colleagues noted their dismay at this, and I could not agree more. I guess we will all just have to wait and see what will really happen with all of these promises aside.

So, this last digression really toke away from the message that I got from the day’s celebrations: that women, the Givers of Life, deserve some recognition from their hard work and sacrifice in the name of family. But this begs the question: does that mean that the men of the world will ever lift a hand and give his wife a break and do her choirs for her?????

07 March 2006

Ali Farka Toure

Today, one of Mali's musical sons died from complications of heart disease and diabetes. To Mali, it is comparable to the death of Elvis Presley or John Lennon. Farka, as he was known here, was the first African to win a Grammy Award in 1993 for his compliation "Talking Timbuktu" with Ry Cooder (of "Buena Vista Social Club" fame). And he didn't stop there. He then won another Grammy in 2006 in his compliation with the coura whiz Toumani Diabate "The Heart of the Moon." He has been described by his friends as a true nationalist, someone who adored all things Mali. To wit, he even owned and operated a hotel in his hometown of Niamfunke, near Timbuktu.

His declining health in the past few months prohibited him from touring and playing here in Mali, so I never got the chance to hear him play live. The non-stop tributes played here over the past couple of days serve as an adequate, albeit not-exactly-the-same, subsititute for a live performance. I highly encourage all of you to check out his music and see why many beleive that West African music, and Malian music in general, is the progenitor for our blues and jazz.