Work Update

I spend a lot of time on the computer. You may have noticed this, considering my frequent blog updates or faster than US email replies. But most of the time I am not messing around, but actually working. I am going to be at time vague in my description of the work, unlike my other blogs where I tell you the color of bananas I ate or exact greeting my host used, because some of this information is not mine to share. That said, I hope it's still sort of interesting.

My first week was field work, understanding the work flow of the system I was going to be modifying.

My next week was projecting numbers for the algorithm / case definition for TB which has been developed by experts throughout the world.

My next week was convincing myself that the numbers I was projecting were real, and much bigger than expectations.

My next week was coming up with my PI and colleagues, novel ways to address the issues I had uncovered and do our work as best as we possibly can, inside of the limits set by finances, culture and reality.

Remember the 25,000 kind souls who answer questions weekly about their health status? Well, our plan was to add a few more questions to the survey and see what the prevalence and incidence of TB in the community. Furthermore, we wanted to trial an "intervention" of TB screening done through a combination of clinical diagnosis, CXR and a fancy new polymerase chain reaction (PCR) machine which would then function as a point of care test (POCT) for the clinic. It is a nice idea, however, logistically very challenging. My work is to figure out how to plan for all this to take place, and ideally, be around to set the stage for the kick-off to take place.

The actual day to day of my work involves a lot of excel. If this sounds familiar to my medical school readers, it feels familiar to me. Instead of sitting in my seat in the library where I am hoping to get a plaque, I am sitting on the second floor of a sweltering office complex in East Africa, sweating (a lot) and putting in numbers and formulas instead of medical facts and disgusting pictures.

Those 25,000 people, have generated a lot of data, and what I am doing is taking the data which seems appropriate from their answers and extrapolating it to the algorithms for our diagnostic chart. And trying to think through all of the steps along the way. Some of the data is readily available from years past--HIV prevalence rate in the community; cough / fever complaints; population demographics. Some of the data is based on expert estimate: how many people will refuse an HIV test, how many people will have a CXR which will rule in for TB and require further testing. And then some of it is based on pure guess: how many people will be willing to walk to a mobile field site for a sample?

So I take all this data: real, estimates and guesses and put it together into an excel spreadsheet. Actually, many spreadsheets, although I am working on making it into one big spreadsheet with a bunch of different workbooks. Is my terminology correct here? I don't know.

And once I have those projections for our community, I have to estimate on a budget. This is interesting, because I always wondered approximately how much people make in places like this, and now I know. I have to try to accommodate for everyone and everything which may cost a penny. My working philosophy is that whatever I can run the budget up to on Excel, I should add between 10-20% because that gives me cushion. I haven't done that, but that's in my head. And this research ain't cheap.

I did this all for my community, Lwak. And the reason I have down time right now, is I am waiting for data from the other site in Nairobi to give it the same treatment. Presuming all of my formulas are right, which is definitely a presumption, but I think a correct one, it is all clerical at this point and things should just fill themselves in. We'll see.