So some of you have astutely noticed that there has been no mention of work among everything I've said about Georgia. I've been waiting until I was really doing something before I started to explain what it is that I'm doing. Honestly, last week, my first week, I didn't even attempt to work for 2 out of 5 days because I had nothing to do, and one of the remaining days all I did was meet with someone for 20 minutes.
The story is that when I expressed interest in going to Georgia and doing some sort of infectious disease research here, I was immediately matched with an AIDS doc at Emory. He's a really important person at Emory and in the AIDS field, so I thought it would be a perfect opportunity to get to know someone with connections, do some really interesting AIDS work, etc. As it turns out, though, he is so connected and so important that neither he nor his secretary had any time to get me set up here- they just threw an abstract, some money, and a plane ticket (barely) at me and sent me on my way.
So I get here with this abstract, the project being a 2-year, fairly straightforward project that actually there is no place for me in. They were like, I'm not really sure what you want to do here, and I'm like me either! So I spent most of last week trying to figure out what my Emory mentor had in mind for me, finally concluding on my own that I could not work on the project because he did not, in fact, set up any project for me at all.
While hanging around, I learned how sequencing of HIV genes for resistance testing is done, which was really cool- but not as cool when you are participating, and at $400 an assay, I didn’t want to ask if I could give a try. I got discouraged pretty quickly when all I was doing was following people around with no clear objective. I have been in this situation before in other countries, and when I am in a resource-poor area, I get to feeling really guilty about consuming more of their time and supplies only for my own curiosity.
So finally, my mentor suggested that I update a paper on the emerging AIDS epidemic in Georgia that he published several years ago, and, if I want, to expand it to include Armenia and Azerbaijan to produce a paper on AIDS in the Caucasus. I absolutely love the idea, because it would justify my inquisitiveness, allow me to learn anything I want about AIDS- for a purpose, and it even seems like a superb excuse for some “business trips” to Armenia and Azerbaijan. I’ll continue to spend a little time with the sequencing/resistance work, AND, the highlight of it all, I’m seeing patients in the inpatient AIDS ward at the ID center a few times a week with one of the physicians.
The clinical exposure I've had has been quite an experience. I guess the people that end up in the inpatient facility are the worst of the worst, and indeed none of them just has one complication. “This patient has HIV, toxoplasmosis, and he might have stomach cancer. He was diagnosed 5 years ago when he was being treated for leishmania.” (Did you know there was leish in Georgia?) “This patient has HIV, cryptococcal meningitis, and he might have TB. He also has heptatitis C.” When I saw patients on Tuesday, there were 4 in the 12-bed ward, and I was almost sure that when I returned on Thursday, 2 would no longer be living- they were extremely sick and had CD4 counts of 2 and 3. Fortunately, both, one with cryptococcal meningitis, and one with tubercular meningitis, had made it to Thursday, but as I was on rounds, one had a crisis and I was again fairly sure that I was going to witness his death right there. His eyes started rolling back in his head, he began breathing very hard, he turned red, and I was wondering if this is what it looks like when someone dies. I haven’t really seen anything like that before and it was pretty traumatic for me. I was starting to feel a little weird and I started to fear that I might throw up, faint, or both. They stabilized him to some degree, though, and when I left he was looking (relatively) better.
Despite a paper I read that HIV/TB coinfection is rare in Georgia, 60% of the patients I’ve seen in the inpatient facility have TB. One particularly touching patient is this woman who came in with a suspicion of TB and was diagnosed with HIV. Her husband is an injecting drug user and she contracted the virus from him. She’s quite dramatic and talkative, and each time I see her she pleads with me to go home and find a cure for AIDS. Judging from the age of her children, she must be fairly young, but she looks 60- rough life probably. When I first met her, we came into her room, and she was reading a book that I recognized as the Georgian-language guide to preventing maternal-to-child transmission of HIV. She was incredibly distraught because she had suddenly realized that she could have unknowingly transmitted HIV to her 2- and 4-year old children. By the time I returned 2 days later, they had been tested and were negative. I got a little choked up by the thankful look on her face.
Now that I have some direction, I’m settling in more here. It’s challenging to be in a developing country when you have no idea what you’re supposed to be doing there, but now I’m on a roll. I’m learning a lot in the clinic and in the lab, so I’m pretty excited now, and if I can get this paper off the ground, it’ll be a great 5 weeks.
We’re headed to Borjomi tonight for the weekend. It’s a resort town in the mountains that was very popular within the Soviet Union, but a little less so now, and the source of the panacea Borjomi carbonated spring water. Hangover? Stomach bug? Just drink some Borjomi! Hopefully the medicinal waters will clear up my little stomach friend I picked up. I’m sure to return with some spectacular pictures, so stay tuned.
Have a good weekend and love your dads. HAPPY FATHER’S DAY DAD!
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