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Aug 12, 2015 · Vaccines and Me

My first memory of vaccines takes me back to when I was about three years old.  Because I was prone to tantrums (and quite good at them, I might add), my mother would bribe me if I promised not to cry during my “shots”. At the time, I valued vaccines because they were a way for me to collect more Barbie dolls or TY Beanie Babies. I decided that the pain they brought was worth the good they also seemed to bring.In sixth grade, I had to do a project in my science class, and I was assigned the topic of Edward Jenner. I learned that Jenner pioneered the first vaccination, which was for smallpox, by studying the cowpox virus. This led me to create a home video in which I was dressed up as Edward Jenner and my friend was dressed as a cow. The video was a hit with my class, and my research on the topic led me to begin viewing vaccines as magical—how else could they prevent people from getting sick?

As a first year medical student taking microbiology, I became more aware of the ways in which vaccines truly impact health, both on a personal and global scale. For example, smallpox has been eradicated, saving an estimated 5 million lives annually. An outbreak of polio has not been reported in some time, making it likely that this debilitating disease may also be a matter of history. If children and infants are immunized, many life-threatening illnesses can be avoided and maybe even annihilated. This is a powerful concept.

My respect for vaccines grew even more when a group of researchers from Mayo Clinic used a high-dose measles vaccine in a clinical trial for multiple myeloma, and one woman was cured. I am not claiming that all cancer, or even all of multiple myeloma, will be eradicated by measles vaccines. However, I do believe that vaccines and our understanding of them may open doors in many fields of research. In a way, I still feel like they are a bit magical. Yet, until I began my internship earlier this summer, I did not realize just how much I have always taken vaccines for granted. I have never stopped to consider what a difficult process it must be for healthcare professionals and mothers to keep track of infants’ immunizations. Luckily, most of this is done by electronic medical records in our country. However, I had never stopped to think about the countries without electronic medical records—the countries that still rely on paper immunization cards. While it may sound easy to keep up with an important paper document in the United States, mothers in many other countries may not have this luxury—especially if they travel miles on dirt paths, often on foot, through rough terrain to reach the clinic. It is also difficult, much of the time, for these mothers to make their journeys back to the clinic for their infants’ subsequent vaccinations. Thus, the infants do not often receive all the shots in a series that are sufficient for complete immunization.

As a result of the challenges faced by mothers who live in poverty, in very rural communities or with low education levels, many infants and children in developing nations do not receive full or timely vaccination. Take Peru, for example. Despite Peru’s relatively high vaccine coverage compared to other developing countries, the children in poverty often do not receive their immunizations. Perhaps as a result, a child under five years of age who is born in the poorest 20% of the Peruvian population is five times as likely to die as a child born in the wealthiest 20% of the population (World Health Organization). This situation is not unique to Peru.

Lauren Braun, a 2011 graduate of Cornell University, discovered this problem firsthand during a 2009 summer internship in a public health clinic in Cusco, Peru. Struck by what she saw as one of the major contributing factors to the low vaccination rates in Cusco—a lack of communication and follow up with mothers in rural areas, Lauren came up with an idea. She found a way to remind the mothers of exactly when their infants were due for vaccines (and which vaccines they were due for), so that even if they lost the paper or were unreachable via phone or mail (which was often the case), the mothers would still be able to look out for their children’s best interests by getting them vaccinated on time. Her idea came in the form of a simple silicon bracelet. Lauren founded an organization to create and promote the use of the bracelets and called it Alma Sana (which translates in Spanish to “healthy soul”). She received a Gates Foundation grant through their Grand Challenges Explorations initiative in November of 2012 and began a Phase I study of her vaccine reminder bracelet in both Cusco, Peru and in Tena, Ecuador.

Alma Sana vaccination bracelets

Alma Sana vaccination bracelets

 

The results were astounding:

  • 91% of mothers said the bracelets helped remind them of their children’s vaccination visits.
  • 90% of mothers said they would like to continue using the bracelets as reminders in the future.
  • 87% of mothers said they would recommend the bracelets to other parents to use.

Due to the success of the bracelets, Alma Sana is in the process of planning a Phase II study—a randomized controlled trial and impact evaluation in Nigeria, Pakistan, and Colombia. The goal of the Phase II study is to determine the bracelets’ effectiveness at reminding mothers of the vaccination dates—to see whether the bracelets’ use impacts vaccine completeness, timeliness, and coverage. The bracelet will also be redesigned for each country to fit parents’ unique needs, preferences, and cultural values. What does any of this have to do with me?

I met Lauren via an interview on Skype because I had read about Alma Sana and wanted to help as a summer intern. I have had the honor of helping to plan the fundraiser for the Phase II study, a crowdfunding campaign, which just launched a few weeks ago!

I have gotten a lot from my experience with Alma Sana.

  1. I had a lot to learn about communications. I admit that I expected that the internship would be an easy job for me, that I would be a “natural” at emailing people in different public relations positions and finding donors for the cause. I am, after all, a good communicator. This was a naive Perhaps, as a medical student, I assumed that anything would easy compared to studying medicine. This is not true.
  2. Public health initiatives really matter. I am still surprised at the results of Alma Sana’s Phase I study and the impact that a simple bracelet had on mothers who truly want the best for their infants but need a feasible way to keep up with the vaccine schedule. Increases in immunization rates lead not only to increases in infant and childhood survival but also declines in life-threatening viruses worldwide. I believe that immunization is the key to the eradication of many illnesses that have plagued humans for centuries. Organizations like Alma Sana can help change the future of how we approach disease prevention.
  3. One person can make a big difference. I am constantly inspired and humbled by Lauren, who left a corporate job at Humana to pursue Alma Sana and her dream full-time. There are many times in life when we encounter problems, and most of the time we turn our backs because we do not feel responsible for creating solutions. Lauren did not turn her back on the problem she found in Cusco. She found a way to help, and she won’t stop fundraising until she is able to test her vaccine bracelet in many other countries. I am now eager to face the problems that come my way in the healthcare profession—and find solutions for them.
  4. We need each other. Ultimately, though, we are all connected. If we are serious about having a sustainable, long-term impact on vaccinating every child, then we all have a shared responsibility as global citizens to support those change-makers. Beyond that, those of us playing the game of healthcare have a responsibility to work as a team, not in isolation.

Whether you are a medical student, a physician, or someone who happened upon this blog, next time you think about vaccines, take a moment to be thankful for what you have at your fingertips in the United States. While you’re at it, take a look at Alma Sana’s crowdfunding campaign page. I encourage you to share this important project with your fellow med students, public health friends, and families so that the full impact of this project on children’s lives can be realized where it’s needed most. Together let’s vaccinate all the world’s children.

Learn more about Alma Sana at: http://igg.me/at/almasana

 

Maggie is a second year medical student from small-town Mississippi who serves as a Mayo Medical School Class Representative. She is interested in end-of-life care and is a collaborator on a clinical research project in the field of pediatric hematology. She hopes to one day have a career in pediatric hematology and oncology. 

 

 

Apr 22, 2015 · Allen

I had never seen someone quite so helpless as Allen*, so away from the grasp of any type of comfort. When I walked into the room, the 20-year-old cancer patient was sitting on the exam table with his legs crossed. He was looking down at his electronic gaming device, pressing buttons randomly, perhaps in an effort to avoid making eye contact with anyone in the room-especially me. The thinning hair on the top of his large round head, his long and scruffy beard covering his chin, and his thin-rimmed glasses seemed odd in juxtaposition to his windbreaker pants, big white sneakers, and toy. It was as if he was both a young child and an aging old man at the same time.

I wanted more than anything to speak with Allen, though I’m not sure what I would have said if I had been given the opportunity to make anything more than small talk. I wanted him to know that I understood what it felt like to dry heave for hours during a chemotherapy treatment, how strange it was to have all your friends be afraid to talk to you and to have your mother treat you like a five-year-old again. I wanted him to know that I understood what he was going through far more than most people did. But that wouldn’t have helped Allen, because while I was standing before him, a medical student following my passion, he was dying.

I resorted to trying to make him smile. Allen, however, did not even seem annoyed, as if my presence was not even significant enough for such a thing. He seemed angry at himself, his situation, and his tumor. But the worst part about Allen’s situation was not his appearance or his sadness or even the fact that his pelvic sarcoma had relapsed for the third time and was only going to get worse. The worst part about Allen’s situation was his mother.

Dr. Stevens* had warned me about Allen’s mother earlier that day, describing her as “unable to handle her son’s reality,” and I had wondered to myself, “Is anyone able to handle that kind of reality?” Now, in the room with Allen and his mother, I understood the real problem. At odds with her son’s uninvolved and “I-don’t-give-a-rip” attitude, Allen’s mother continuously bombarded Dr. Stevens with suggestions for treating her son based on her own internet searches.  She spent at least an hour threatening to take Allen to other countries to become a part of clinical trials that “actually worked.” It was her anger that was more apparent than anything else. She had so much anger building up inside of her small five-foot frame that she verbally attacked Dr. Steven, blaming her for the rapidly proliferating tumors inside of her son’s body.

It was incredibly difficult for me to listen to a patient’s mother reprimand and lecture Dr. Stevens. Though she had every reason to be angry that there was no cure for her son, I also understood that her anger was not what Allen needed. It was equally as frustrating to listen to her list off the whole gamut of phase I clinical trials that she had found online, all of which she believed were being hidden from her son. Although Dr. Stevens patiently explained that phase I clinical trials were not based on efficacy but based on dosing alone, this did not change the mother’s insistence to look into everything from “viral injections of Streptococcus”  (which is actually a type of bacteria) to the use of marijuana to “slow the tumor’s metabolism.” Dr. Stevens patiently nodded, jotting down notes and promising to examine all of these studies herself.

Maggie_pic1

Maggie and her family during her treatment

As I stood in the corner feeling useless alongside the automatic paper towel dispenser, I couldn’t take it anymore, so I chipped in. “I remember when I was sick, my mother and I did so much research, and there is just so much information on the internet that it’s all very overwhelming and misleading.”

Within seconds I realized I had made a mistake.

Allen’s mother’s expression transformed into one of both surprise and disgust. “I don’t know what you had, but it was nothing like what my son had. My son relapsed. You did not. You could not possibly understand.”

My intention had been to explain that I understood how much information was out there but that I trusted that my physician and the doctors at this hospital. What I’d wanted to do was remind them that they were being treated by experts that had access to even more information than they’d found online. But instead, I had offended a woman whose little boy was dying right in front of her. In that moment, I felt deeply ashamed and embarrassed. Never before had I felt so hurt and responsible for hurting someone else all at the once.

Maggie_pic2

Maggie and her family

After explaining that I in no way meant to compare myself to her son, I apologized and resumed silence for the remainder of the appointment. I watched and learned as Dr. Stevens kindly and lovingly listened to the mother continue to spout off the names of bizarre experimental drugs. And without ever arguing with Allen’s mother, Dr. Stevens managed to facilitate a peaceful appointment. Dr. Stevens later explained that she found it necessary to allow family members to have their turn to rant because if they didn’t do it in the clinic, they’d do it even more at home. She couldn’t allow herself to take anything the family did or said personally. Their anger and frustration and even rudeness came from a place of desperation and love for Allen. 

I do not want to be the type of physician who attempts to erect an emotional barrier between themselves and their patients, but I now understand that there are certain times when my feelings don’t matter—because the feelings of my patients and their families matter more. There will be times when, as physicians, we just have to listen and accept the words that patients or their parents throw at us, because sometimes listening is the most important thing we can do.

*Names have been changed to ensure confidentiality

Maggie is a first year medical student from small-town Mississippi who serves as a Mayo Medical School Class Representative. She is interested in end-of-life care and is a collaborator on a clinical research project in the field of pediatric hematology. She hopes to one day have a career in pediatric hematology and oncology. 

Nov 12, 2014 · Eddie

photo to put in blog post

For aspiring pediatricians, a love of stuffed animals is a prerequisite

It was just a day of shadowing in primary care. I didn’t expect to be enlightened or changed at all from the experience. What could be so exciting about general pediatrics when there was the exciting world of pediatric oncology? What could be so interesting about children with common colds when kids with cancer existed? I anticipated boredom.

For the first part of the afternoon, I observed and wrote down all of the individual jobs of each person who worked in the clinic—from the woman at the front desk to the medical assistants responsible for the physician’s scheduling. Although informative, it wasn’t the most exciting of tasks.

Finally, it was time to follow the doctor. She was a third year resident, and for pediatrics that meant it was her final year of residency before she would choose a specialty—or begin her practice as a pediatrician. She looked stylish with a stethoscope draped around her neck, and her kindness immediately put me at ease. She led me down the hallway, which was decorated with bright colors and crayon-scribbled pictures. We entered a room, and there, in his father’s arms, was Eddie*.

Eddie did not have cancer. He did not have a Hickman line or a port or an NG tube. He did not have anemia or low platelets or mouth sores from chemotherapy. Instead, Eddie had the beginnings of a full head of hair on his head, a pacifier in his mouth, and fully functioning reflexes. As we put him on the infant scale, Eddie began to cry—the touch of the cold metal on his skin was difficult for the newborn.

And in response to Eddie’s tears, the strangest thing happened to me; I felt laughter rising up out of me and a smile plastered itself on my face. Here in front of me was a normal, healthy baby. Here was a miracle—and not a miracle that needed cytotoxic drugs to stay alive, but a miracle that needed nothing but continued love and nourishment. Eddie was a gift.

I left that day with a skip in my step and a smile on my face. Though I didn’t feel like I’d made any difference in Eddie’s life, he had made a difference in mine.

*Names were changed in this piece to ensure confidentiality

 

Maggie is a first year medical student from small-town Mississippi who serves as a Mayo Medical School Class Representative. She is interested in end-of-life care and is a collaborator on a clinical research project in the field of pediatric hematology. She hopes to one day have a career in pediatric hematology and oncology. 

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