WHOlights from Week #3

As my third week at the WHO was drawing to a close, I began to realize how fast my internship was passing by. I really wanted to make the most of my remaining five weeks, including leaving some sort of lasting product/result/finding and drawing as much insight from my relationships with colleagues as possible. I also wanted to be involved in work that challenged me, or at least tapped into the way my mind works. Sure enough, that's what happened.

During the first couple weeks, as I assembled country profiles and gathered MDR-TB patient outcome data from GLC projects, I had noticed some peculiar inefficiencies in the whole process, and discovered in particular a crippling lack of coordination and consolidation between all of the databases used within the GLC mechanism (you remember the diagram I drew earlier with all those different interconnected bodies?). What I mean is that there were all sorts of gaps and overlaps in what kind of information an individual like myself could access, stemming purely out of the fact that all the entities within the GLC mechanism (e.g. Global Drug Facility, monitoring and evaluation, Global Fund, etc.) were deliberately separate and autonomous. I envisioned a new system for organizing and linking all the information and, sure enough, my supervisor Wieslaw confirmed that this was exactly what needed to be done. He requested that I describe and diagram out the new organizational structure and then had me present it to several other members within the department. I really felt like what we were proposing would facilitate -- even revolutionize -- how the GLC mechanism operated.

Beyond that new database coordination project, I'm really enjoying my other projects as well. As more and more National TB Program (NTP) managers provide me with their M/XDR-TB patient data, it is becoming sort of a detective game to determine where and why different discrepancies are occurring in their data. Another neat thing I've noticed is how even though the only real "patients" I'm dealing with are numbers on massive Excel spreadsheets, I feel like I'm really able to see past the rows, columns, formulas, and tallies to real people with a real disease that is really treatable and really preventable given adherence to proper programmatic therapy. When I trace across the row corresponding to patients admitted "After failure of category II treatment" and find where it intersects with the column for patients whose outcome post-GLC treatment was "Failed" and I see the number 12, I can't help but think, "Wow, there's a dozen people who have not only failed category I treatment, not only failed the even more intense category II treatment, but have now once again been unable to fight off the disease." Even more sobering is when I see 30 patients in the "Still on treatment" category in 2007, and then look at the new end-of-2008 data and find that 6 of these patients are now classified as "Died." No doubt some of those patients had spouses, children, and jobs that they left behind, if not also a trail of people whom they unwillingly infected. But in contrast, believe it or not, I actually get a wave of joy when I see the numbers in the "Cured" column go up. I admit that in the past I've been guilty of denouncing jobs that require staring at spreadsheets, even while I plated and pipetted mycobacteria in the lab last summer. But I really never imagined that the data contained in such a sheet could carry so much weight until coming to the WHO. The numbers in these boxes have intense stories behind them. Apparently, whether conducting experiments at the lab bench or data collection in the GLC, every cell counts.