working at the ministry

it's a little ironic that the shortest amount i have in thailand is the one where my mentors have given me the most (defined) project and work. due to crazy scheduling issues brought about by my own disorganized life last year, im only here for barely six weeks on the OC Hubert Fellowship, a program sponsored by the CDC Foundation. i am learning a ton and really wish i could stay here way longer! a short run-down of the project:

the project im working on is looking at the utility of Binax testing to detect Strep pneumoniae. S. pneumo. is one of the leading causes of death in children under five (a vaccine is available, but it's expensive for this part of the world) and also affects tons of adults. unfortunately, it's a tricky bug and hard to culture because it likes to autolyse itself after 24 hrs (or less). enter the Binax test, which is an immunochromatographic assay (think pregnancy test, with two lines - one control, one appearing if it's positive) that was created to detect S. pneumo. in cerebrospinal fluid (CSF, or spinal tap fluid) and urine. however, someone came up with the idea to try and use it with the blood they were already getting for blood cultures here as part of a larger pneumonia surveillance study. preliminary results show that the Binax test is really sensitive at detecting S. pneumo. and often will be able to find cases that have negative subcultures. today i'm visiting a provincial lab near the thai-cambodia border and got to tour the hospital and facilities, see how the lab is run, and collect some important information. i also got the chance to speak with some research nurses about hiv/aids, answer their questions, and watch them consent and enroll some patients in this other respiratory pathogen study. it was refreshing to see that they respected patients' wishes to refuse enrollment, although i still find it much more difficult to say no here as a patient (especially if you're hospitalized and don't have a lot of money).

in any case, i really like the office where i'm working as a whole. i have two mentors, an epidemiologist and a physician with an MPH, and they're very supportive and task-oriented, which i find refreshing after previous experiences here. i usually meet with at least one of my mentors everyday or every other day, am learning some basic SPSS skills to analyze data, and feel helpful because i can help bridge the thai-english divide (although most of the staff speak excellent English). the office where i work is housed in the Thai Ministry of Public Health (Thai MOPH) but it's part of the International Emerging Infections Program (IEIP) within the Thai-US CDC collaboration. TUC seems pretty cool to me so far and has made a big difference in these two provinces where the pneumonia surveillance activities are occurring by building lab capacity - the hospital im visiting in Sa Kaeo today just got a PCR machine last month! i'd be interested in seeing how the improvement in diagnostics have impacted clinical care, as the head lab person i talked to today noted that their ability to diagnose a common pathogen like S. pneumo. has increased dramatically (they used to only successfully culture one or two cases a year, and now it's close to 3% of all blood cultures done! i very much appreciate the chance to visit the sites in the provinces and am getting a much better global view of the work that's going on with the Thai-US projects (and hope to be more involved in the future!)

more work updates later. last random fact: did you know S. pneumo. is really prevalent in the Arctic Circle? me neither, but apparently the poster we're preparing is being held in Iceland this year because it's heavily affected by S. pneumo. (and they always pick locations based on where the pathogen they're focusing on is super prevalent). kinda cool, though iceland seems to be a super pricy place to have a meeting!