11/24/06

Not sure if I'm in Long Acres or Kabulonga or what. I just walked, at 19:35 from the Stringer's residence about 2 Km to this place. I was aiming for a place formerly called Jay Lin, that Maggie and I love especially for their pepper steak. For 45,000, here at Chrismar, I can't decided on the garlic steak or the pepper steak. I'll save the pepper steak for next time. What prices these days here. A liter of petrol is over a dollar, so we're looking at $4/gallon. It might be a good thing that I don't have ready access to a vehicle.

Got two wonderful emails from Estelle today, including an e-card wishing me happy father's day. Things would be better if She and Maggie were here. And this side of town, I'm so removed from the familiar areas - I guess it's an opportunity to learn some new places. I must mind my money carefully though.

One Muzungu in the place, a middle-aged man with close-cut head.

My work thus far revolves around quality control issues fro the thousands who are no on Antiretrovirals (ARVs) in Lusaka. One task involves developing a data extraction instrument with which a chart review team will, logically enough, extract data from the special pink folders that contain medical records of our patients. A second related task is the development of a data analysis tool to use in conjunction with the collected data. The overall aim of these two tasks is to identify problem areas, and them of course to minimize them. Possible problems involved contraindicative coincidence, if that makes any sense. For example, these combinations may be deleterious:

AZT and a Hgb < 10

EFV and pregnancy

NVP and Rifampicin, the latter being a TB drug, and other major contraindications that have slipped my mind in a postprandial state.

Looking them up in the notebook, the remaining three are Rifampin + Protease inhibitors, ddI + D4T, and AZT + D4T.

If any of these combinations are found, then every effort must be made to correct the situation by substituting with more appropriate treatment. These are the nuggets that I came to make my own. Another thing I learned is in the case of TB and HIV coinfection, treat TB first, if possible with risk of mortality being the only criterion to give one pause - not clear on that.

My second project is to assist in formulating a process to capture loss-to-follow-up. In the time course of treatment, approximately 20% of 12,000 currently on ARVs have not made their last appointment. It is urgently important to identify these patients and track them down. While the process of making a flow chart is in and of itself flat boring, the thinking and  cognitive analysis of the details is very stimulating. Of those who have missed appointments, the priority grous to find, in order, are:

1. those on ARVs, because we don't want them to develop resistance having placed the selective pressure of treatment on their virus, thus limiting their future treatment options;

2. those eligible for, but not yet on ARV therapy, because their inclusion criteria portend increased morbidity if they go without treatment; and

3. those who screened, are HIV+, and do not necessarily need treatment imminently, but with whom we would like to maintain contact for the time in the future when they may benefit from treatment. It is a privilege to be involved in these efforts.

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I had an idea for getting folks to make a return visit to the clinic. It is an idea for  a radio advert that would read as follows, in Bemba, Nyanja, and English:

"Have you visited a clinic for HIV treatment, but missed an appointment? You are welcome to return at your earliest chance. Don't wait until it's too late, for the sake of your health, and the wellbeing of your family."

Then measure if there is a change in the late-list, by quarter, to see if the ads are effective.

Would we need Project Management Group Approval? Who is involved in the Executive decision-making process?

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Then I went on to make a list of Bwats for what I'd like to accomplish here in Lusaka this Summer. I categorized them into Personal, Work, and Travel. Looking at the list of 20 or so objectives, I am glad to say I met them all.