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Six Lessons from a Resource-Limited Setting

In my first three weeks as a Fellow with the Infectious Diseases Institute (IDI) I’ve learned six valuable lessons on how to do more with less in a resource limited setting.

1. Collaborate.  Partnerships can provide access to external resources, for example Clinic clients are referred to neighboring Mulago hospital for ECGs since the IDI clinic does not have its own machine, and IDI researchers can access and use expensive flow cytometry equipment in the adjacent Makerere University College of Health Sciences building. 2. Recycle.  Equipment originally obtained for use in clinical trials is recycled to enhance routine care for patients in the IDI clinic, for example punch biopsy equipment from a large clinical trial on diagnosis of Kaposi’s sarcoma (KS) is now used to provide a free KS biopsy service with a three to seven day turnaround, which is much faster, cheaper and less invasive than the excision biopsies that are routine in Uganda.  3. Improvise.  Space is at a premium at IDI, so researchers have come up with ingenious solutions.  The new TB clinic was set up in the open air, since the Ugandan climate is warm all year round, with a cover to keep staff and patients dry when it rains. Clinic staff use a dumbwaiter to transfer serum samples to the lab directly above for testing. 4. Simplify. In rural areas outside Kampala, the power supply can be unreliable, so technology has to be adjusted to suit the setting. Since electronic data capture for clinical studies is not feasible, paper forms and a datafax system that are more robust to power cuts are used to manage clinical data from the field.  In the IDI clinic, which has stable power, real time quality control (QC) is used for data entry into the Electronic Medical Records system, which has significantly reduced data entry errors and reduced the need for extensive QC checks later on. 5. Prioritize. The IDI Clinic has three kinds of appointments – Pharmacy Rx refill, nurse or doctor visits.  This task-shifting allows the doctors to prioritize spending their time with the most seriously ill patients. 6. Standardize. IDI is introducing standard templates for protocols and operating procedures that have been developed this year by Pfizer Global Health Fellows Jenny de Gelder and Carlo Bello so that each new project team doesn’t have to reinvent the wheel. It will be important for me to build these factors in to the new strategic plan that I am developing for IDI Research to ensure successful implementation in IDI’s East African setting.  But I’m also learning some valuable lessons that I can bring back to Pfizer when my assignment here is complete.

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