Global health from the kitchen table

By Audrey Smith, MS Student

Audrey Smith

When I applied to the IGHS master’s program, I never expected to do a full year of school online, and I certainly did not think I would be conducting a global health capstone project from my kitchen table in Larkspur, California! We have all had to do a lot of adjusting of expectations this past year, but my experience with IGHS and the capstone period has been a pleasant surprise.

I was very lucky to find a mentor, Dr. Teresa Kortz, who has conducted research on pediatric sepsis at a major public hospital in Dar es Salaam, Tanzania. I have always wanted to go into pediatrics, and my past clinical research was in pediatrics, so it was a match made in heaven! Even better was the fact that this research was based in Tanzania, which holds a special place in my heart.

When I was thirteen years old, I spent a month in Moshi, Tanzania, and was lucky to have a fairly authentic look at what life is like for Tanzanians. This early experience is probably what set me on the path to global health, because I saw a lot of disparities in health, quality of health facilities, disease stigma, and gender inequity when I compared my experiences in Tanzania to my own privileged life in the Bay Area. It has been a goal of mine to improve global health equity ever since.

The data for my capstone research project was collected at Muhimbili National Hospital in Dar es Salaam, which is the only hospital in the country with pediatric subspecialty care and a 24-hour public emergency department. The hospital cares for thousands of septic children every year, who come from every region of the country.

After speaking to Dr. Kortz about this specific cohort of patients, I decided that a worthwhile research question would be whether delayed presentation to care for pediatric sepsis (over 48 hours from fever onset to arrival at the hospital) was associated with mortality and what the risk factors might be for delayed presentation. One of my hypotheses is that children from families of lower socioeconomic status will have less of a chance at timely presentation to care, especially when transportation from a far-off region of Tanzania is so costly, both financially and in guardians’ time away from work.

This capstone project is quantitative, so I’ve been putting my new biostatistics skills to work in the statistics software R. When I first started, I felt pretty lost with the code; I’ve experienced a cyclical process of running into new error messages, complaining to my family members, sending a desperate email to Professor Yea-Hung Chen, and blessing the people who write on online statistics forums about how to work around those problems. I am starting to get the hang of it now, which makes me excited because I feel I am gaining a skill that will probably help me in my planned future career as a physician. I think I will always want to keep doing research alongside clinical work.

I look forward to presenting my findings to the staff at Muhimbili National Hospital in July. My biggest hope is to help the hospital identify which of their patients are most at risk of delayed presentation and death, which would ideally give them ideas for possible interventions. Translational research has so much potential to make real, immediate change in the field of global health, so I am very excited to see where this project leads.