Fellowship Site: Uganda
Mulago Hospital Complex is the teaching hospital of Makerere University
Faculty of Medicine, and is one of two national referral hospitals
in Kampala, with an official bed capacity of 1200. The Medicine
Department is one of 23 departments in the Faculty of Medicine.
It has 5 general medical wards (3 non-private, one private, and
one emergency ward) providing services for in-patients. The medical
team structure consists of two medical teams for each ward. A ward
firm typically consists of one consultant/senior lecturer/professor,
one registrar/lecturer, two residents and two interns. Training
opportunities at our institution include numerous clinical and research
conferences (journal clubs, grand rounds, etc.) and research programs
in Public Health.
Makerere University has a long-standing history of academic excellence
and collaborative research with American universities. At present
we are actively involved with research collaborations with Case
Western Reserve University (CWRU), Johns Hopkins University (JHU),
Columbia University and the University of California, San Francisco.
These collaborations provide extensive funding for our research
activities in Uganda. Specifically, CWRU was awarded a major contract
as a National Institutes of Health-sponsored TB Prevention and Research
Unit (TBRU). The JHU collaboration has HIVNET grants to carry out
studies of perinatal transmission of HIV in Uganda. Columbia and
JHU have NIH grants to study the epidemiology of HIV in a community-based
cohort (Rakai Project). The Medical Research Council (MRC) has funding
to do HIV transmission studies in a rural cohort of southwest Uganda.
Located on the Mulago campus is the TB treatment center, a comprehensive
outpatient research and treatment center for TB patients. Patients
with suspected TB are referred to the center from the community
as well as the National Tuberculosis & Leprosy Program (NTLP), and
go through a screening process for study eligibility which includes
group and individualized education and counseling, phlebotomy, nursing
and physician visits, and radiography. The Scholars are based here.
The TB treatment center is a part of the Tuberculosis Research
Unit (TBRU, www.cwru.edu/affil/tbru/index.htm),
a collaboration based at CWRU, that consists of TB research and
treatment in Uganda, Brazil and the Philippines. A variety of other
studies related to tuberculosis and HIV are being conducted through
the Uganda-CWRU Research Collaboration.
The following are summarized here:
-
Delaying HIV disease
progression with Punctuated AntiRetroviral Therapy (PART)
in patients with tuberculosis in Uganda
-
Kawempe Community (KC)
Health Study
-
A prospective study
of shortening the duration of standard short course chemotherapy
from 6 months to 4 months in HIV-non-infected patients with
fully drug-susceptible, non-cavitary pulmonary tuberculosis
with negative sputum cultures after 2 months of anti-TB treatment
(TX)
Current Scholars are involved in the PART and KC studies. Within
PART, one fellow's project involves an assessment of the presentation
of tuberculosis in HIV-infected patients. She will analyze various
clinical, laboratory and chest radiographic factors as they relate
to CD4 count. This will be used to create a model of predictors
of CD4 count in patients presenting with tuberculosis. This study
will be highly applicable in Uganda as roll-out of antiretroviral
therapy continues to progress. Many clinics that will be distributing
ARVs may have limited, if any, availability of CD4 testing.
Within KC, one Scholar is writing a case series on the disease
course and outcomes among the cohort of pediatric patients and based
upon the longitudinal experience gained in the study. He also plans
on becoming involved with the immunology aspects of the KC study,
especially surrounding questions of pediatric immunologic response
to TB. Being a community study, there is opportunity for clinical
work at the Komomboga Community Health Center. He is currently spending
3 mornings a week working side-by-side with one of the medical officers,
seeing and working up patients from the community.
Housing Availability:
Temporary housing is available at the Makerere Guest House and
Mulago Guest House, both of which are within walking distance of
Mulago. Approximate costs are $35 and $25/night respectively and
include breakfast. Other meals are available for $5-10. More permanent
housing can be found, with prices varying widely (between $250-500/month),
depending on location, number of tenants sharing, security and other
associated costs.
Immunizations Needed for this Site:
See the U.S.
Centers for Disease Control Web site and The
Yellow Book: Health Information for International Travel.
Also, Scholars should check with the University Hospitals of Cleveland
Travelers'
Clinic.
The NIH/FICRS program mandates that all Scholars see a physician
prior to their assignment abroad. The physician will need to complete
and sign a brief form.
Safety and Danger Issues:
See the U.S.
State Department Web site and read the Worldwide
Caution for information.
Language Requirements Other than English:
None. English is sufficient.
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