Along the Nile

Residency student Christina Nelson travels to Egypt in search of a disease

An ancient nation, known for empires,pharaohs and mythology – a modern country, focused on development, international relations and cultural leadership. Regardless of the perception, Egypt has captivated the minds of millions in search of the country’s identity, antiquities and even political allegiance.

In a nation of 74 million people, there is still much to be discovered in the way of health, and that includes disease.  According to the World Health Organization (WHO), Egypt is facing challenges in its health surveillance system, budget deficits and a gap between the responsibilities of health services and medical education.  The result, like any other stressed system, is a shortfall in the health of the country’s people.

Enter support from the United States Centers for Disease Control and Prevention (CDC) and preventive medicine resident Christina Nelson, MD.  During the summer of 2009 Dr. Nelson traveled from Colorado to Cairo to begin working with an Egyptian hospital conducting respiratory disease surveillance in partnership with the CDC.

The two-month program emerged Dr. Nelson in a hospital-based surveillance program primarily in Cairo and Damanhour, three hours to the north of the capital.  WHO estimates Egypt experiences 16,000 new cases of tuberculosis each year, yet these numbers are based on antiquated or lacking surveillance models.

According to Dr. Nelson, many children are diagnosed with TB and undergo lengthy treatment. However, research conducted during Dr. Nelson’s time with the surveillance program concluded not all the children had TB.  In fact many of the children were suffering from a different respiratory disease.  By correctly diagnosing the disease, the children received proper treatment.  The new treatment had the benefit of being significantly shorter in duration than standard tuberculosis treatment.

The outcome was rewarding and a perfect match for Dr. Nelson’s interest and expanding skill set.

“Christina entered our program with a strong interest in international health, in particular the epidemiology of communicable diseases that disproportionately affect children,” comments Dr. Carolyn DiGuiseppi, director of the preventive medicine residency program. “Her rotation in Egypt provided her with an outstanding opportunity to develop a core epidemiological skill – the design of a surveillance program.”

For more than twenty years the residency program has trained physicians in core preventive medicine skills. According to Dr. DiGuiseppi, the core skills enable physicians to work on a population level to prevent disease and injury and promote health.

“The skills developed include communication to professional and lay groups, program and needs assessments, outbreak investigation, interpretation of relevant laws and regulations, formulation of policy and development and implementation of plans to address a health problem, delivery of clinical preventive services, and evaluation of the effectiveness of clinical services for both individuals and populations,” states Dr. DiGuiseppi.

Yet, the program also individualizes residents’ training and education. Each resident focuses on his or her particular career interests such as global health in Dr. Nelson’s case.

Building on this core set of skills, Dr. Nelson’s trip to Egypt also included conducing vector-borne disease surveillance at a local slaughter house and writing protocols responding to gonorrhea. But Dr. Nelson favored her time with the hospital because of the opportunity for applied learning and career development.

“I worked closely with hospital staff on a multiphase project,” says. Dr, Nelson. ”I wrote parts of the next phase of the project and had hands on independent experience.”

This experience adds direct value to Egypt’s health system and Dr. Nelson’s career interest in global health. Nearly fluent in Spanish, Dr. Nelson previously volunteered for medical programs in Nicaragua, Argentina, Dominican Republic and Guatemala. Her extensive international experience ranges from Mt. Everest and Mt. Kilimanjaro. In all her passport contains stamps from 16 different countries.

For a physician in search of a career oversees, finding the disease meant finding the experience. And that seems like a good start.