WHOlights from Week #5 and #6

In place of the usual highlights, here's the summary that I submitted for my mid-summer report:

My internship at the World Health Organization headquarters in Geneva, Switzerland, has been a fascinating and enriching experience so far. Although only five weeks have passed since I first arrived at the WHO’s glass citadel on the hillside overlooking Lake Geneva, I have already learned so much about the complexities of formulating and implementing global health policy, as well as the advantages and challenges of operating within a multinational organization. I have also grown in my understanding of myself and my own passions for tackling intricate problems and improving the lives of those who live in sickness and poverty.

For two months, I am interning in the Green Light Committee (GLC) Secretariat, which is housed within the WHO’s Stop Tuberculosis (TB) Department. The GLC works to ensure that patients worldwide receive adequate treatment for multidrug-resistant tuberculosis (MDR-TB). Through an intricate mechanism of partnerships, funding, and procurement, the GLC approves and enables countries to obtain quality-assured drugs at concessionary prices and to administer programmatic treatment to reduce the emergence of further drug resistance. The GLC also provides technical assistance to the various programs in these countries and applies on-the-ground experiential evidence to advise the WHO on MDR-TB policies and guidelines.

Throughout the past five weeks, I have had the opportunity to work on several projects. The first of these has been the collection and analysis of annual MDR-TB patient outcome data. At present, the GLC has approved nearly 50,000 patients for treatment in 93 projects spanning 60 countries. Each year, the projects approved by the GLC are asked to record and report the treatment outcomes for their patients. This information is extremely important for many reasons. For one, the aggregated data from all the projects reveal precisely how effective the GLC mechanism really is at combating drug-resistant tuberculosis. When analyzed over time, these data also demonstrate the system’s capacity for scale-up. Moreover, when analyzed across different countries and healthcare-delivery models, or according to socioeconomic characteristics and medical history, these data reveal the factors beyond drug quality and prices that influence treatment success. And on an individual project basis, the annual patient outcome data allow the GLC to evaluate and address the needs and achievements of each project. As for my own work, I have been corresponding daily with national TB project managers around the world to request their data and offer them assistance in the reporting process. Because the WHO cannot force its member nations to do anything and because data ownership belongs to these constituent countries, these data requests require a delicate balance between urgency and courtesy. After receiving the outcome reports, I cross-check the data for every project and every year, ensuring that patients have not been misclassified or outcomes misreported, as such discrepancies would undermine the validity of the information. In the next three weeks, I will be entering the cleaned data into the GLC database and beginning to perform the analysis, which may have direct implications for the GLC’s Annual Report in 2009. Asking the right questions and doing the necessary detective work will hopefully reveal whether countries could better adhere to the WHO MDR-TB management guidelines, or whether the policies and treatment regimens themselves need to be revised.

In addition to gathering, organizing, and analyzing the annual patient outcome data, I have also been working on optimizing the data reporting process itself. Currently, a number of obstacles hinder the GLC from getting a quick and accurate report of treatment outcomes. Aside from the inevitable challenges of punctuality and language translation, many TB project managers provide data in which patients have been classified in the incorrect registration group, outcome category, or cohort year. Thus, in order to streamline the reporting process, I have designed algorithms for categorizing patients that are derived from WHO guidelines and definitions. I have also begun to distill and simplify the reporting instructions in hopes of eliminating some confusion that may be the reason behind erroneous data.

The third project I have been working on has involved creating profiles for GLC approved countries. These country profiles are crucial when it comes time for countries to apply for funding or forecast drug needs, as well as for evaluating such characteristics as laboratory quality and political support. During the assembly of these profiles, I have noticed how scattered the necessary source information is, so I have begun to draft a new template for these profiles that consolidates and automatically updates its information. Per the request of my supervisor, I have also designed a new structure for organizing and connecting databases among the various arms of the GLC mechanism.

Apart from my individual day-to-day projects, I am learning just as much from my conversations and interactions with the GLC staff themselves. In fact, one of the highlights of my internship so far has been getting to know the other members of the department. Whether sitting in the office, chatting during a coffee break, or enjoying a department dinner, I have thoroughly enjoyed listening to my colleagues speak about their decisions to pursue careers at the WHO and their experiences working in the organization.

As for my own impressions, I remain fascinated by the broad reach of the WHO, impressed by its authority in every arena of health, puzzled by its inefficiencies, and awed by its expertise. Five weeks into my summer experience so far, I have very few concerns regarding my internship. Perhaps one minor concern would be that, with a few projects progressing simultaneously, I would like at least to be able to produce and complete something concrete by the end of the eight weeks, though this remains uncertain. In addition, the work is not always incredibly challenging or diverse (and can be tedious at times), though the posters of sobering health statistics and sick children that are pinned up around the office quite effectively humble me and remind me of the gravitas of each task, email, and meeting. Without a doubt, it has been a true privilege to be surrounded by WHO staff and interns who hail from all corners of the globe yet share one common passion, and I am as captivated by their diversity as I am inspired by the dedication and selflessness with which they all work. I am deeply grateful for the opportunity to intern alongside the experts this summer, and to learn about and contribute to cutting-edge tuberculosis policy.