This summer, Stanford medical students contributed to projects in communities around the globe as part of the Medical Scholars Research Program. In this special back-to-school Q&A series, five students share their experiences developing preventive medicine strategies, gaining hands-on clinical experience and conducting field research.
Having lived in Tanzania at various times during the past three years, Stanford medical student Laura Saucier decided to return to the East African country this summer and conduct research aimed at improving surgical care for pediatric patients.
She spent the summer working at Muhimbili National Hospital, the largest hospital in Tanzania, investigating factors associated with delayed presentations and treatment among children with conditions that required surgery. Determining what common factors contribute to adverse surgical outcomes among pediatrics patients could provide useful information in designing interventions and informing decisions regarding funding and resource allocation at local hospitals.
A larger goal of Saucier's research is to help address general challenges in developing countries related to access and provision of surgery including: scarce resources, inadequate infrastructure, low socioeconomic conditions and poor nutrition. She also hopes the data, along with other studies quantifying the mortality and morbidity contributed by surgical conditions, will strengthen the global medical community's view of surgical care as a fundamental and necessary component of international health initiatives.
I recently spoke with Saucier about her research and involvement in community projects in Tanzania.
What were your methods for identifying various factors related to delayed treatment and poor outcomes for pediatric surgical patients?
The factors that I considered encompass all aspects of quality, quantity and accessibility of surgical care. These include factors within the health-care system - such as inadequate resources, personnel, facilities, and services - as well as community factors like socioeconomic circumstances and infrastructural limitations. To identify these factors, I reviewed patients' charts to investigate medical histories of delay and circumstances surrounding any adverse outcomes. I also talked with patients' parents concerning delayed presentations and interviewed health-care providers concerning adverse outcomes. Lastly, I organized health-care provider focus groups to discuss and rank the contribution of various factors to morbidity and mortality among pediatric surgical patients.
What do your early findings show?
I think the most interesting finding thus far is related to the factors involved in delayed presentation. One of my initial hypotheses posited that inadequate health education and awareness would be responsible for a large number of delayed cases. However, this does not seem to be true. Rather, it seems that even parents with no education who live in very remote villages waste little time bringing their children to a health-care facility. Yes, they may be illiterate and have no knowledge of the biological basis of disease. But, the important point is that they know that something is wrong with their child even though they may have no idea what it is.
The problem arises at the rural dispensaries, clinics and district hospitals. In such health facilities there is usually a lack of necessary diagnostic equipment, especially imaging technology, surgical capacity and trained health-care workers. Misdiagnosis or false assurances of "nothing is wrong with your child" delay children from reaching referral centers like Muhimbili National Hospital where they can receive the surgical care they need.
My current project is preliminary research aimed at identifying around 10 to 20 contributing factors that will then be studied prospectively for one year. Contributing factors can be defined as those factors that are temporally distal to onset of a surgical condition, and that increase the likelihood of adverse outcome. Contributing factors include barriers to accessing surgical care, which often contribute to delay, and inadequacies of surgical capacity. As traditional Global Burden of Disease (GBD) risk assessments quantify Disability Adjusted Life Years (DALYs) attributed to various risk factors, the year-long prospective study is designed to quantify the DALYs attributed to the 10 to 20 selected contributing factors. The goal is to adopt the parlance of public health in order to demonstrate the degree to which different factors contribute to morbidity and mortality of pediatric surgical conditions. Hopefully, this may begin to inform priorities for funding, resource allocation and cost-effective interventions.
You have been active in soccer and tutoring projects in Tanzania? How did you get involved in this work?
While living in Tanzania in 2009, I volunteered in the operating room at the district hospital, found physics and chemistry students who wanted tutoring and worked with a local soccer enthusiast to organize and fund the Bagamoyo Sister's Soccer Club. When the Bagamoyo Sisters began practicing, most of the players took to the pitch barefoot and in skirts. I shared this information via e-mail with my former hometown coach, and we launched a partnership between the Simsbury (CT) Soccer Club and the Bagamoyo Sisters' Soccer Club. The first thing we did was to provide cleats, shin-guards, practice clothes and uniforms to every player. I have returned to Tanzania twice since in the past three years and continued with the same projects.
The Bagamoyo Sister's Soccer Club is still one of the only girls' teams in Tanzania. These inspiring young players are bravely pioneering women's sports in a society that has yet to accept the soccer field as a proper place for young ladies. The Simsbury Soccer Club has continued to raise thousands of dollars for the girls' school fees and living expenses, and has sent over hundreds of pounds of soccer equipment and sports clothing. Our girls are all on partial or full secondary school scholarships for soccer; without this tuition reduction and without the generous donations from Simsbury, very few of our players would be able to be in school right now.
As for the students I am tutoring, I am convinced that they are most motivated, deserving and wonderful students that ever opened a science book. All of the remarkable young men I work with were driven onto the streets by family deaths and abuse and therefore did not enter primary school until they were teens. Now in their twenties, they have advanced to the final years of secondary school. They work incredibly hard, and in return I try to make science fun rather than a chore. We climb coconut trees and use Newton's equations to estimate the speed of coconuts dropped from various heights. We go to the beach to float in the salt water and learn about buoyancy and density.
What was your most memorable experience working in Tanzania this summer?
I really don't think I can pick just one. There are memorable experiences of unusual medical cases and fascinating surgeries, of adorable and engaging little patients and of inspiring families who allowed me the privilege of hearing their stories. There are experiences that I never want to forget; but there are also memorably tragic experiences that I'd try to forget if it were not for the opportunity for growth - both as a person and as a student of medicine - that such experiences provide.
Previously: What I did this summer: Stanford medical student investigates health statistics and costs in Costa Rica, What I did this summer: Stanford medical student investigates early detection methods for glaucoma, What I did this summer: Stanford medical student works to improve emergency care in Cambodia and What I did this summer: Stanford medical student helps India nonprofit create community-health maps
Photo by Laura Saucier