Why would a newly-qualified doctor from the UK want to go to Brazil?

Some of you may already know that I’m off to Brazil for the next couple of months, but I thought I’d write something for those of you interested in knowing more about exactly what I’ll be doing out there.

How Zika first got me hooked

Back in 2016, when Zika took Latin America by storm, I was captivated by my news feed as I followed the spread of the epidemic. Thousands of mothers, mostly from poor communities and already living challenging lives, suddenly found themselves with the additional burden of having to raise disabled children and with limited resources to help them in doing so.

I decided I wanted to experience the excitement of working at the heart of an outbreak of a new infectious disease: the fast-paced research environment, the sense of urgency and the challenges of tackling such an unknown and unpredictable virus. I was excited by the idea of working in a huge international collaboration and being part of something where, for once, the whole world is working together towards a common goal.

Above all, however, I wanted be able to do my bit, however small, to help the families affected by this terrible disease. Throughout medical school, I’ve often felt like a bit of a spare-part on the wards, conscious of being there mostly there for my own learning, with limited opportunity to really make a difference to patient care. However, the Zika outbreak presented an opportunity to change this. I felt compelled to move on from being a passive observer and to put my skills and knowledge into action.

What am I doing now then?

I’ve just finished my final medical school exams (yes, you may now call me Dr Masters!) and have just one last ‘elective’ placement to complete before I graduate.

It’s with this placement that I’m off to Recife in north-east Brazil, which is right at the epicentre of the Zika virus outbreak. Recife is the capital of Pernumbuco state, which has registered the highest number of Zika cases in Brazil and has probably been more affected by the virus than any other city in Latin America.

zika-epicenter
Map of Brazil showing cases of microcephaly, centred around Recife.

If you’re interested in learning more about what makes the part of Brazil that I’m visiting so distinct, I’ve written more about both Recife and Pernambuco state

Where does neurology fit in?

I’ve always been fascinated by the brain and am planning to train further to become a neurologist. Therefore, it made most sense to me to try and get involved in research around the neurological complications of the Zika virus.

The most publicised complications of Zika were the birth defects it caused in children born to pregnant women with the virus. The virus causes problems with the development of the brain, and babies are born with small brains and small heads (‘microcephaly’). The consequences for the children vary widely. Some of will have only a mild learning disability whereas others will be more severely affected, wheelchair-bound and likely dependent on carers for the rest of their lives.

I’ve written more about microcephaly and the effects of Zika virus on babies here.

What is perhaps less well known is that Zika has also been found to cause neurological complications in adults, most commonly a type of paralysis called Guillain-Barré Syndrome (GBS). This relatively rare condition affects people after an infective illness, such as diarrhoea or a chest infection.

GBS causes a weakness of the muscles which starts in the feet and creeps up the legs, eventually affecting the arms and trunk as well. If the paralysis climbs high enough that the diaphragm and muscles of breathing are affected, patients have to be transferred to an intensive care unit and intubated so their breathing can be supported by mechanical ventilation.

Fortunately, it is self-limiting and patients improve spontaneously, although some patients never fully recover and are left with residual weakness. It’s Zika’s links with this condition, GBS, that I’ll be working on during my time in Recife.

I’ve written more about what GBS is and why it’s so important here as well as an article on what we know about the links between GBS and Zika.

Who I’m working with and what I’ll be doing

hospital da resturacao
The Hospital da Resturação, where I’ll be working

I’ll be based at Hospital da Resturação (the largest public hospital in the city), working with neurologist Dr Lucia Brito, who was the first doctor to notice that patients with Zika virus were devloping GBS as a complication. The connection between Zika and GBS has since been scientifically proven, but there are still many unanswered questions (which I’ll explain in a future post).

I won’t be practicing as a doctor (seeing patients on my own, diagnosing and prescribing) as I’m not (yet!) licenced to practice medicine in Brazil, but I will be helping out in the hospital and clinics, hopefully playing much more than a passive ‘observer’ role.

I’ll be working with people from a group called ZikaPLAN, an EU-funded consortium linking 25 research and public health institutions around the world.

ZikaPLAN is divided into 15 ‘working groups’ and I’ll be involved with the groups on the ‘neurological manifestations of Zika‘ and the ‘pathogenesis‘ of Zika’s neurological complications.

I’ll be joining researchers at the Oswaldo Cruz Foundation (FIOCRUZ) — which functions Brazil’s main public health institution and the research arm of Brazil’s Ministry of Health. I’ll also be working closely with researchers from the University of Glasgow, University of Liverpool and the International GBS Outcome Study, which is co-ordinated from Erasmus University, Rotterdam.

logos
Some of the institutions I’ll be working with

Most of the research I’ll be involved with will be on large ‘epidemiological’ studies. This means monitoring, tracking and collecting data about what happens to people with Zika-induced GBS so that we can get a better idea of how the disease presents, how common it is and what the outlook is like for the patients who suffer from it. We’ll be looking for things like whether there are any factors that influence which patients infected with Zika get the GBS complication and trying to get a better understanding of the biological mechanisms which result in the syndrome.

If you’re really interested in what I’m doing, I’ve written another post explaining what my day-to-day work looks like in Recife.

Here are a couple of videos from the working group leads at ZikaPLAN explaining a bit about what their research aims to do:

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Over the next few days I’ll be writing a little more about the Zika virus itself, GBS and some of the specific questions that our research hopes to answer.

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