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Erica Dwyer
South Africa
See previous Erica Dwyer submission 
May 2004
Things Change - and for the Better Too!
The time since the last "Notes from the Field" has been filled with difficult decisions and major transitions. I implied in the previous entry that I was not entirely happy in my lab. The project I had initially proposed was no longer an option, and I was finding it difficult to find my place, especially since instead of being free to assemble a worthwhile project, I was assigned a minimal amount of routine work. When I finally received permission to pursue a research project involving RNA sequencing of local HIV strains, the necessary reagents ran out, and I was not able to order more.
The problems in the lab were due to lack of funding and a very difficult dynamic among lab members. Clearly, the goal of my Fulbright was not to go into work every day, sit around, check email and do literature reviews, while getting upset about the dynamics in lab and the waste of resources and talent in an environment where our work could have had so much positive potential! Fortunately, there are many worthwhile organizations in Durban trying to address the needs surrounding HIV/AIDS care, and my interests, knowledge, expertise and energy could be put to good use elsewhere.
I am now active at McCord Hospital and its Sinikithemba HIV/AIDS clinic. Sinikithemba, (“We give hope,” in Zulu), was one of the first places in this area to provide specialized HIV/AIDS care, including antiretroviral medication. My Fulbright project has been transformed into a “best-case scenario”: I am pursuing interesting research, while simultaneously benefiting the hospital. My responsibilities include coordinating a study concerning knowledge of antiretrovirals among staff, helping an investigation of health outcomes at the HIV clinic, and assisting with the HIV mother to child transmission prevention programme. Sinikithemba recently received a large grant, which will allow us to provide anti-HIV medications to many more people at a lower cost. In preparation for this exciting expansion of a clinic already bustling with activity, I am coordinating an audit of Sinikithemba's current services.
Incidentally, this clinic is one of my former lab's sources for HIV-positive samples. While I used to process blood to study the immune cells of patients I had never seen, I am now working with doctors and nurses who are providing care to those same patients. I am also becoming painfully aware of the administrative structure and effort that is necessary to make such care possible. Health care workers may provide excellent services, but when patient charts are lost, or blood doesn't arrive at the lab on time, this reduces the quality of care. Similarly, patient care suffers if the lab does not provide results in a timely fashion, or risks confusion of samples.
In addition, any lab research extracted from patient samples is lacking if feedback between researchers and clinicians concerning the patient's clinical history is insufficient. These challenges of effective organization, communication and documentation are constantly being faced in the HIV/AIDS care and research communities in Durban. But in this arena of big thinkers and people with large ambitions, there are few who feel a calling to tend to what might be termed the "nitty-gritty" or "basics" of clinical research. Few find the task of creating a filing system compelling or interesting, and the need for training of administrative staff is often underestimated.
These days I find myself incredibly busy, (working weekends and holidays, generally), and I continue to meet many interesting people... many of them Americans with international/public health interests, who are working in Durban for a few weeks or months. While I loved being thrown into South Africa on my own, it can be comforting at times to link up with people with a similar background. I am still enjoying myself here... and thrilled that the weather remains warm and pleasant (beach!) despite the fact that we are supposedly heading into winter.
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