ASTMH: Day 3 (I think)

If today is Tuesday, than it's the official third day of the ASTMH conference (and yes, it's all run together that much that I no longer know). The day started with the first session at 8, just like yesterday. I attended the session on non-malaria fever in Africa, thinking it might be applicable to my job, but that might have been a mistake. I don't know if it was that I was so tired from the night before or if the speakers were just that non-engaging, but I found myself falling asleep during the presentations. I actually stood up during the last presentation, which was on a new algorithm for treating pediatric fever, because I actually wanted to stay awake to hear what she had to say. It was a really good presentation; her group had gone through and tested a lot of children (I forget the number) who came into the hospital with either fever, cough, or diarrhea, and then went back and correlated the signs and symptoms at presentation to what they actually had (malaria, pneumonia, dysentery, etc). They came up with a new algorithm for evaluating children that, when used properly, reduced the number of kids given antimalarials or antibiotics who didn't really need them. Pretty powerful stuff, if they can get wide-spread use of the new algorithm.

The second session I went to was also on global health, and wasn't really that great. Each session had multiple speakers, and the one I wanted to hear was about training community health workers on proper diagnosis and treatment of kids (a lot of the same stuff as the session before). However, the presenter didn't really discuss what the teaching was, just that it didn't work very well. Oh, well. At least I get continuing education credit for being there.

The best session all day was the lunch session on tropical medicine in temperate climates. It's a session given every year by the people at the London School of Tropical Medicine, because they have an entire ward of the hospital for tropical medicine. This year's cases were loa loa (African eye worm), West African trypanosomiasis (African Sleeping Sickness), and adverse reactions to malaria medications. Just for something to gross you out, here's a picture of loa loa:

Yes, that is a worm in a person's eye. It's gross (all pictures of eyes are gross), but the patient was properly diagnosed and treated and is now doing well (at least, that's what the doctors making the presentation tell me).

Tomorrow is my poster presentation on my dengue project, so I hope that goes well. After I'm done standing by my poster, I'm packing up my stuff and then heading for the airport, because it'll be time for me to go back to Savannah and work for a couple of days before I leave for Tanzania to climb Mt. Kilimanjaro (should be a good time).

Exploring Atlanta and Beginning ASTMH

Yesterday we didn't have any obligations at the conference until the opening plenary session in the evening, so I decided to explore. I have been to Atlanta before, but the most recent time was in 2004, when I was at Emory doing research for the summer. That was obviously a long time ago, so I had a lot of exploring to do. I started the day by sleeping in (it was, after all, Sunday, and I had taken a pretty big exam the morning before), and then headed down to the Underground Atlanta area (less than a mile from my hotel) to take an electric car tour. It was pretty similar to the trolley tours in Savannah, only without the on-and-off that the Savannah trolleys offer (to allow you to explore on your own between stories from the tour guides). I did learn a lot about the downtown Atlanta area, though, including some of the history of the King family as we drove by the house where MLK, Jr was born and the church where he would occasionally preach. I also learned what this is. Any guesses?

It's actually a holding cell (I know, right?). Back in the day (before 1905 or so), this part of Atlanta (Inman Park) was pretty far away from the city proper, so when someone had committed a crime, they would lock him into this tiny little cell and turn on the light on the top, so the paddywagon knew to come pick him up and take him to jail. Well, Atlanta gets hot in the summer, and after enough people died in these, they decided that maybe it wasn't the best way to hold prisoners until they could be taken to jail.

After the tour, one of my classmates from last year and I explored World of Coke, because it's free with a military ID. I wouldn't recommend it to anyone who has to pay. Completely not worth it. We did like this picture of a WWII Army nurse, though:

Last night was the opening plenary, by the CEO of Save the Children, Carolyn Miles, pictured below (pic from the internet):

It actually wasn't the best speech ever, but it wasn't bad. I think the problem was that she's a business-type person, speaking to an entire room of people who study tropical diseases about why children are important and why studying the diseases that kill them is important. I think we got that message already.

Today I started the day with clinical updates from the last year in malaria, dengue, yellow fever, and TB. The malaria updates were very well done and very helpful, but the other presenters of the other three diseases spent too much time going over the history of their respective diseases and not enough time talking about updates. After that session was a talk on tropical dermatology, which made me feel good about myself and my ability to recognize pictures of rashes. Of course, it's the same 100 pictures used for the same diseases, so whether I'm just recognizing the pictures or if I understand the rashes or not is another issue entirely. Here's one of the pictures I saw a lot of in my tropical medicine studying:

This is chromoblastomycosis, and if I didn't know better, I'd swear it was the only picture of this disease, for how often it's used. Anyway, after tropical derm was lunch/clinical cases, which was about echinococcus and given by a completely uninteresting speaker, so my friend and I left early for our midday break, which I spent going on a short run (3ish miles). Then we returned for more clinical updates from the CDC, and then it was time to break for the evening for drinks and pizza. I forget the name of the restaurant, but it was delicious. And I got to do a lot of networking, which is always helpful.

Tomorrow will be more of the same (as far as the lectures, not the exploring of Atlanta). Hopefully I learn something applicable to my new job.

ASTMH

This past week, I was hanging out in Philadelphia for the American Society of Tropical Medicine and Hygiene conference. It was pouring rain, but since the conference was indoors, that wasn't really that big of a deal (until my deputy program director insisted I go play tourist, but I'm getting ahead of myself).

The conference started on Sunday night with a student and trainee reception, which wasn't terribly exciting, but it did include free appetizers and wine. I got to talk to a couple of medical students, grad students, and people applying for medical school about the things that they've done and want to do, so that was pretty neat. After that was the first plenary session, which was mostly focused on how global aid is dropping and the impacts that will have on global health and disease prevention and treatment.

Monday started the endless series of sessions, each an hour and forty-five minutes long and consisting of a series of speakers, each talking for fifteen to twenty-five minutes. I went to sessions on a variety of topics, from dengue (since I'm doing my residency project on it) to global health, clinical sessions, and neglected tropical diseases. I actually really enjoyed the sessions on neglected tropical diseases (which are diseases that only affect the poorest of the poor and don't have a lot of research dollars associated with them). Of these diseases, there are a few that the WHO is slated for elimination or eradication.

Let me back up to explain the difference between those terms: elimination is the cessation of transmission in a given geographical area. For example, polio has been eradicated in the Americas. Eradication means that there is no more transmission anywhere in the world. The only disease that has been eradicated is smallpox. The next step, after eradication, is extinction, meaning that there is no more anywhere, and no diseases fall under that definition, including smallpox (there are still lab samples and who-knows-what from the former Soviet Union).

So, back to what I was saying. There are four diseases that the WHO wants to eliminate/eradicate by 2015 (yes, it's coming up quick). One is trachoma, which is the number one cause of blindness from an infectious disease worldwide. I would include a picture, but pictures of eyes gross even me out. It's actually a Chlamydia bacteria that infects the eyelids, causing scarring that scratches the eye and leads to blindness. The treatment (before one is completely blind) is surgery and antibiotics (azithromycin). The prevention is facial hygiene and clean water. Another is onchoceriasis, also known as River Blindness. This is slated for elimination from the Americas by 2015. They'll focus on eradication at some other point.

As you can see, they're close to elimination in the Americas, and there's still a lot of work to be done in Africa. It's a parasitic infection that causes (wait for it...) blindness, and is transmitted by the bite of a black fly.

Number three is lymphatic filariasis, also known as Elephantitis. Here's an illustration (less gross that way):

It's also caused by a parasite, which blocks lymphatic flow, causing backup and the swelling, like in the picture.

The final one is Chagas Disease, which only occurs in the Americas:

Once again, caused by a parasite, transmitted either by the bite of a kissing bug or from mother to child. There's much less transmission from bug bites now, but there's still quite a lot from mother to child or from blood transfusions.

That was a lot more about that than I anticipated writing. Anyway, that was my Monday and Tuesday, and then on Wednesday, it was sessions in the morning and playing tourist in the afternoon. The hotel was only about half a mile from Independence Park, with the Liberty Bell and Independence Hall. Unfortunately, it was pouring rain, so I was quite soaked, but fortunately, it being a Wednesday afternoon and with that weather, I didn't have to deal with large crowds. Here are some pictures:

Inside Independence Hall, where the Continental Congress met and discussed both the Declaration of Independence and the Constitution. The chair in the middle was where George Washington sat when they approved the Constitution.

Liberty Bell. I wasn't all that impressed.

And the outside of Independence Hall. And yes, there's construction going on. And yes, it was really raining.

Next week, back to clinic.

Clinic, Week 2

I meant to write this while at work on Friday, and then yesterday during my day of doing absolutely nothing (no, really--I woke up, went on a run, and then only got off my couch to get food. It was kinda glorious). But I didn't, so I'm writing on Sunday night.

So here's how this past week of clinic work went:

Monday: No clinic (my preceptor at Whitman-Walker was still on vacation from Thanksgiving). So I sat at WRAIR and worked on work. And went to a two hour long safety briefing, which was incredibly boring, even with the company of my two fellow residents.

Tuesday: Travel clinic at Ft. Myer. I actually had patients! It was a lot of fun (and actually fairly busy). I had a retiree who is now a consultant who will be going to Afghanistan for twelve months, so he got a couple of vaccines and a year's prescription of doxycycline, which is an antibiotic that is also used as an antimalarial. He'll have to get a two-week prescription for primaquine, another antimalarial, to take when he gets back. The next patient was another retiree, going to Ghana for his mother-in-law's funeral. He's been out of the service for almost twenty years, and despite still having family (well, family he married into) in Ghana, he has never been to Africa, so he got quite a few vaccines, and also a prescription for antimalarials (Malarone, in his case, which is a drug with very few side effects but a pretty high price tag), as well as all sorts of counseling about how to take care of himself while he's traveling. Patient number three is a dependent (meaning she was never in the military, but her husband was) who was born and raised in El Salvador and is going back for Christmas. El Salvador does have malaria, but not much, so I gave her some bottles of bug lotion with DEET and told her to be careful going out at night (which is when the malaria mosquitoes bite), but she didn't need any medications. She did need a couple of vaccines, though, which we were more than happy to provide. The final patients were a family (mother and three kids under 10) who were going to Bahrain to visit the husband/father, who is stationed there temporarily. Bahrain is a pretty safe place, when it comes to diseases, so all they needed were typhoid shots and prescriptions for antibiotics in case they get diarrhea, and they were good to go. No malaria there.

Moral of the story: whenever you're traveling to the developing world, go see a doctor. You're probably going to need a few shots and drugs before you go.

Wednesday: This was supposed to be prev med clinic at Bethesda (excuse me... Walter Reed National Military Medical Center), but instead, we had a talk about the embassy bombing in Nairobi in 1998, by the doctor who was in charge of the research lab then (she is now retired but still working for the Army). It was a really interesting talk, if for no other fact than to demonstrate how far we've come as a military when it comes to treating and evacuating casualties from big, traumatic events. And this bombing was a big, traumatic event--there were around 400 killed and 1200 injured.

Thursday: TB clinic at Montgomery County. This was, well, not what I expected. I pretty much just observed while the medical director saw patients. The first was an elderly woman who recently immigrated from China and had a positive TB skin test and x-rays that looked like she had TB in the past. She never had any sort of treatment, so she was given a prescription for four months of isoniazid and rifampin (two drugs that are used to treat latent, or inactive, TB), and then a whole bunch of counseling on why it was important. The next few patients were all follow-ups who have active TB and come into the clinic once a month to check on the symptoms, see how they're progressing, and so on and so forth.

Friday: No clinic (there's never clinic on Friday). I finalized my orders for attending the American Society of Tropical Medicine and Hygiene conference in Philadelphia (where I am right at this moment) and did some mandatory online training, and that was about it.

So now I'm in Philly, with one day of the ASTMH conference down and four to go (it's a pretty long conference). I'm not presenting anything, just going to the sessions and, I hope, learning stuff. We'll see how that goes.