‘Medicine’ Articles at WOW Fellowship Blog

Post 1: Pediatric Epilepsy Internship at Boston Children’s Hospital

Hello Everyone! My name is Nandini Mandaloju and I am a rising senior majoring in Biology and Neuroscience. This summer, I got an incredible opportunity to continue working as a Senior Pediatric Epilepsy Clinical Research Intern at the Loddenkemper Lab at Boston Children’s Hospital/Harvard Medical School. I would like to thank the Hiatt Career Center for awarding me the Social Justice WOW Fellowship and the Loddenkemper Lab for supporting me throughout this internship!

One of the primary missions of the Loddenkemper Lab, led by Dr. Tobias Loddenkemper, is to prevent, predict, detect, and treat every seizure and status epilepticus in children before it occurs. The Loddenkemper lab uses machine learning and predictive algorithms to detect early warning signs of seizures through the Empatica Wristband. The Empatica Wristband is a revolutionary tool in medicine as it measures physiological data such as heart rate variability and electrodermal activity. We combine these seizure monitoring tools into our in-patient clinical studies to best develop epilepsy care in pediatric patients.

My day typically starts at 7:45 am, as I take the commuter rail to Longwood. One of my best friends, Hima, happens to take the same train and works nearby so we usually walk together to our labs and stop for coffee on the way! Upon reaching my lab, I usually like to spend a few minutes settling down before my morning huddles and lab meetings. Then, I train the incoming interns on the project that I worked on last summer. This project studies the effects of anti-seizure medications on the autonomic nervous system. I am currently working on another project that focuses on Sudden Unexpected Death in Epilepsy (SUDEP), where I analyze EEG reports and label different types of seizures. For these projects, I utilize databases such as PowerChart, and REDCap. Additionally, I learned how to utilize medical terminology, read EEGs, and recognize different types of seizures. I also accompany research fellows of the lab and enroll patients in clinical studies.

One thing I love about my lab is how they encourage their interns to learn more about their goals and broaden their knowledge and perspectives about medicine. I always make an effort to attend the Grand Round Lectures conducted by Harvard Medical School where doctors discuss important topics in medicine such as how to improve the care of children with limited English proficiency. I find it super inspiring to connect with physicians from the hospital and learn more about their perspectives on topics that aren’t often discussed through this lab. I also got an opportunity to shadow my primary investigator, Dr. Loddenkemper in the Outpatient clinic and In-Patient service, and learned how he interacts with pediatric patients with great enthusiasm, intelligence, and care. While at work, I also enjoy spending time exploring the hospital with my fellow interns through activities such as visiting the rooftop garden at Boston

Here is an amazing view from the rooftop garden at BCH!

Children’s Hospital and getting sweet treats such as lemonade and cupcakes. This internship has further solidified my interest to pursue a career in pediatric medicine and I am very excited to continue to build my skill set through this amazing journey!

It takes life-long passion to be in academia

My teammates and I (third person from the left)

Many people think that doing research in the medical field is about constantly gaining more knowledge, keeping up with advances and new findings in the field, and coming up with the meaningful unanswered questions. Research is also known to involve continuously doing experiments, analyzing and gathering data. From my personal perspective, I have discovered that research is a great learning environment. In order to contribute to any research project, the learning process never stops. The deeper your understanding is, the better your hypothesis will be. You are constantly learning while doing experiments and looking at your data. The hands-on experience is a crucial part to help me understand the projects.

In the Lichtman lab, people learn from each other on a daily basis: when the principal investigator and the postdoctoral researcher teach students new techniques or when students discuss underlying concepts with one another. It takes kindness to spare time to help other people learn. It takes cooperation and effort for everyone to be involved. Most importantly, it takes passion to keep all of this going.

The World of Work is not like university life. At school, students are taught by lecturers, assigned homework, get checked on for completion of homework, and get tested during exams to be evaluated. In the World of Work, how much you can learn and how much you can achieve entirely depends on you. There isn’t any limit about what you have to learn. There aren’t any criteria for you to be evaluated upon. People will not tell you what you should be doing, and they will not keep track of your work. However, they will evaluate your performance. They will want to know whether you can set up and carry out experiments independently, whether you can generate accurate data, and whether you can effectively analyze data. Furthermore, your performance is not the only thing that will be taken into consideration. It is also very important to maintain a good relationship with other people in your workplace and to be helpful to team members.

The most important skill that I have learned this summer is how to do research. I have learned how to come up with a question and how to set up the experiments and different techniques that can be used to do research. This will help me in the future whether I take lab courses at Brandeis or I do research as part of my career in the medical field. Besides my passion in patient care, I really appreciate the enormous impact of research in medicine. It may take a lifetime effort of scientists to do research, but the impact could be life-changing for improving patient treatment and health care services for all people. The World of Work has also taught me a lot about what I should do in order to be a worthwhile person and valuable team member. It’s all about having the passion and the resilience to pursue your passion.

Halfway in Quito, Ecuador- Hospital Pablo Arturo Suarez

El Pancillo statue which stands in the historic center of Quito

Working in the hospital for the last four weeks has been an incredibly fulfilling and engaging experience. Additionally this experience has illuminated the underpinnings of a foreign health care system first hand. From 7am-12p.m I assist the nurses, doctors, and patients to the best of my ability in order to help the day run easier and quicker. The medical culture in Quito is quite different than that of the States- there is a much more relaxed and calm aura, even in the emergency rooms, female doctors and nurses spend full days in heels, and there is often many patients in a consultation room. Beyond these small observations, however, the desire to improve and get up to speed with western medicine is evident and exciting to watch. All of the doctors and nurses I have assisted have been warm, inviting-and love explaining everything they do in a way that I can understand. Life in Quito has also been very interesting. Ecuadorian culture has been wonderful to be a part of and observe-as it is heavily tied to family, Catholicism, and salsa dancing which serve as channels to meet locals. The history of Quito and Ecuador as a whole is also fascinating and the more I learn, the more I have come to understand the evolution and reasonings of the health care system here.

I have also had the chance to connect with many volunteers in the hospital from around the world. It has been really interesting to hear about their countries’ healthcare system in contrast to that of Ecuador. Given the opportunity to converse with healthcare professionals and learn hands-on has been an experience completely different from studying at Brandeis. I have gained many medical skills such as taking blood, stitching, and taking vital signs which are skills that I would not attain until later in medical school. I have also learned that 80% of Ecuadorians use the universal healthcare system, which is supplied by the government. Unfortunately, there are not enough hospitals to support the demand. Consequently, often the hospital I work at and others in Ecuador tend to be in hysteria, with as many people jammed into the waiting rooms as possible. A great article that discusses these issues can be found here. As the United States moves toward universal healthcare, I think it will be important to recognize the weaknesses of other universal healthcare plans to know how to structure and improve it. If you are interested in a quick synopsis of the healthcare system in Ecuador, PubMed does a great job.

A skill that I have gained and am continuing to work on is my ability to communicate in Spanish to the patients, doctors, and other healthcare professionals. More than becoming well versed in Spanish medical terminology, I have been more confident in approaching doctors and nurses and asking them about their experience and what they do. Finding the confidence to follow my curiosity in a very different culture is something that I was afraid I would be unable to do. I look forward to continue pursuing my curiosity academically, as a future healthcare professional, and as a visitor in a foreign country.

– Paulina Kuzmin ’17

Ate logu, East Timor!

See you later, East Timor! The 9 weeks I spent in East Timor went by so quickly. I cannot believe that summer is over!

Over the course of my internship, I shadowed many of Bairo Pite’s staff. I followed the doctors around during their rounds and when they went to examine the patients. They discussed treatment plans amongst each other and let the nurses know of any changes on the patient’s status chart. This is how rounds typically run in the morning and in the afternoon. Some days I hung out with the laboratory staff. I watched them run lab tests. I have also worked with the clinic manager at the clinic organizing in her office and the stock room so we know what supplies we have.

Slides of sputum stained by the Ziehl–Neelsen method to identify TB

Me looking at the stained slides. The bacteria for TB would show up bright red (amongst the blue) if the sputum is positive.

At the clinic, I learned how to use an EKG machine. I admit that I cannot truly read the EKG results, but I know where to place the electrodes and run the test. With the medical students, I also learned and practiced taking blood pressure with a stethoscope and blood pressure cuff. Sometimes to check on a patient, I took their blood pressure. Sometimes I helped take patient histories; I asked them how they were doing and ask if they have certain symptoms in Tetun. I learned how to assess the patient by looking and examining the patient’s hands, face, and just getting a general look at the status of the patient to see if they are breathing heavily or any other acute problems that needed to be looked at. Other tasks I did included taking patients to the National Hospital to get chest x-rays or to get consultations with the specialists working there. I let the patient know where we were going and accompanied them for their visit.

To build off of this experience during the rest of my time at Brandeis I will continue to promote the Bairo Pite Clinic with Project Plus One on campus. I will share my experiences to club members and to members of the community at activities such as the Millennium Campus Conference. I am continuing to pursue a career in healthcare and learning more about global health. I want to learn more about the politics involved and examine the differences. I also want to learn more about the current policies of disease treatments such as the WHO guidelines for tuberculosis (TB). I hope to return to East Timor to the Bairo Pite Clinic (in the processing of becoming a hospital) with more knowledge and education.

If a student is interested in an internship at the Bairo Pite Clinic, I advise them to take advantage of the opportunities available. Because a lot of people visit the clinic, there are a whole range of cases to learn from. There are also mobile clinics (scheduled doctor visits and health education to villages in East Timor) which students can go on. The people that organize the mobile clinics do really great work and it is a great opportunity to see how and where most people of East Timor live. I believe they will have the ability to really make the internship their own at the BPC. My advice for a student interested in this field is to not be afraid of saying no to things that they are not comfortable doing or that they do not know. They do not want to cause more harm than good and it is important to be honest.

My concepts of social justice have been enforced. With the sad and violent history of East Timor, they need healthcare to repair some of the damage and to help East Timor rebuild and stand up strong again. Listen here for an interview Dr. Dan, the founder of the BPC, recently gave a few weeks ago during a trip back to US about his experience. However, I have learned, like with all things, change takes time. It would take time for East Timor it implement changes and to learn what would work for their country and what would not.

Alice Luu ’14

Diak ka lae?

Diak ka lae is used in Tetun, the local language of East Timor, for “How are you?” The literal translation is “Good or bad?” In response, people usually reply “diak”, meaning good, or “lae”, meaning bad. Diak ka lae is one of the many Tetun phrases and words I have learned here in my time in Dili. Although I am far from being fluent, I know enough phrases to understand some of the patients and to get a basic patient history. As I go on rounds with the doctors and follow up with the patients, I am getting more comfortable in a health care setting. Most importantly, I am also getting comfortable interacting with the patients. Being familiar with the language is one big step in communicating and interacting with patients and their families at the clinic.

bpcsign2 — Bairo Pite Clinic sign outside clinic gates

After spending over a month at the Bairo Pite Clinic, I am definitely seeing how a health clinic in a developing country like East Timor operates. I work almost daily with the staff and volunteers in providing health care for its patients. I observe and interact with a variety of staff members vital in running the clinic. However, the BPC is steady changing as health care in East Timor progresses. As I am working, I am witnessing the failures of the system and the improvements being made. I believe this knowledge I am gaining is important in becoming better informed as a future primary care physician.

Since I have started working at the clinic, I have been exposed to many medical procedures used to diagnose and evaluate patients. As I am picking up the language here, I am also becoming familiar with the medical techniques and tools being used during these examinations. I am able to understand why these techniques are being used when a doctor uses them and I am able to provide these tools when a doctor needs them. These skills would be useful in the future for work in a health care setting and for facilitating patient care.

n952 — Me and other volunteers with our N95 masks (masks that protect us from TB) on

I am most proud of everything that I have learned so far at the BPC and the fact that I am able to make myself useful around the clinic despite my lack of knowledge. Most of the volunteers at the BPC are medical students with some medical experience. In the beginning, I was worried that I would not be able to get the learning experience I need or be able help out. However, the doctors and medical students have been very willing to explain and teach me if I had questions. This in return helped me understand what was going on and be able to help them and by extension, help the patients.

Alice Luu ’14

Many volunteers from all over the world hanging out in the administration office

11,817 Miles Later

The Bairo Pite Clinic (BPC) is a community health center founded after East Timor’s struggle for independence from Indonesia that left the nation’s health service infrastructure severely damaged. The BPC strives to provide primary health care to some of the poorest people in the world. Every day they serve over 300 patients from all over the country, and they are open until every patient is seen. The clinic is established and financed entirely by contributions and at times is aided by governmental and non-governmental organizations.

xxx place -- date — Patients waiting to be seen at the Bairo Pite Clinic

At Brandeis, I am a member of the Project Plus One Student Chapter, which supports the Bairo Pite Clinic. Being involved in the club, I became familiar with the clinic and its efforts to empower the local community to provide healthcare for its members. I also met with a few Brandeis students who have volunteered at the clinic in the past with the organization and I wanted to get more involved by travelling to the clinic. I applied to the clinic through their application process and was invited to volunteer for the summer.

At the BPC, I participate in rounds every morning at 8:00 with Dr. Dan, the director of the clinic, Dr. Simon and other volunteer medical doctors and medical students to see the in-patients. I spend time with the volunteer doctors overseeing assignments and assisting with the application of treatments, making sure the appropriate medications are taken as prescribed and helping nurses take vital signs and record information. I facilitate in patient admittance, in recording patient history, and in communicating and relaying information between doctors, nurses, laboratory technicians, and other staff members at the clinic.

After my first week of the internship, I am finding myself falling into a routine at the clinic. In the beginning, it was a bit disorienting trying to figure out the system of the clinic, locating which ward was what or where, and trying to help out in a capacity that I am able to. Now I find myself able to introduce and explain the clinic to new medical volunteers and understand some of my limitations and capabilities at the clinic. Every day I observe rounds in the morning and in the late afternoon. After rounds, the medical students are delegated tasks or follow-ups with patients. This week I was able to observe a few Ziehl-Neelson stains, which is a method to test patients for tuberculosis (a common illness in East Timor), a lumbar puncture, several electrocardiograms (EKGs), and diagnostic tests for malaria and Dengue fever. The medical students and doctors have been very kind and supportive, explaining many of these procedures to me and the results of these tests. I feel that just by being here for only a week so far, I have learned quite a bit.

For this summer, I want learn more about how health care in a developing country operates, and how it faces its problems, such as a limited supply of resources. Already by observing the doctors and the clinic, I am seeing the pieces to this puzzle. In addition, I hope to continue to observe and learn more medical procedures and medical techniques used at the clinic and be familiar with the tools used by these providers.

Alice Luu ’14