Profile: Fulbright-Fogarty Fellow Navid Shams analyzes long-term outcomes in ICU patients in Peru

November / December 2013 | Volume 12, Issue 6

By Arthur Allen

When Navid Shams first got to Lima, he found it difficult to transition to Peru's chatty culture. He'd arrive home from a hard day's work, but couldn't get into his apartment until his landlady and neighbors had engaged him in 45 minutes of conversation.

"I thought I was going directly home, but that almost never happened!" he said. "After a while, though, I started to appreciate the value of just telling stories, and listening."

As it turns out, the power of narratives became the focus of Shams' research in Lima, where he completed a 10-month Fulbright-Fogarty Fellowship in Public Health, working with Dr. William Checkley, an assistant professor of medicine at Johns Hopkins University.

An older woman is seated in a full-sized lung measurement machine, a man stands next to her and helps adjustment the equipment
Photo courtesy of Navid Shams

As a Fulbright-Fogarty Fellow in
Peru, Navid Shams worked to
improve long-term outcomes in
ICU patients. He also helped train
his Peruvian colleagues to use
sophisticated machines like the
lung measurement machine pictured.

His research, examining the local standards of care for patients with acute lung injury, expanded to explore long-term health issues of intensive care unit (ICU) patients. Shams conducted a series of lengthy interviews with patients six months after they left the ICU to track their recovery over time.

"The patients have problems that the specialists who follow them may not appreciate," he said. "Their pulmonary function usually gets better but that process can take months or even years. The other issue to address that's newer and interesting is mental health. How did the experience in the ICU affect their sleep? Did it cause depression and anxiety? As doctors we sometimes think of them being in a coma, but they remember a lot - Moments where they felt trapped, people drawing blood, tubes in their throats. Being in that environment leaves them with a kind of post-traumatic stress."

One unique aspect of Shams' project is the extended time he spends with each patient interviewing and examining them to gain a very broad view of their health status. "I really get to understand what they went through," Shams observed. "And that's what's missing from their normal care. It's really comforting for them to hear that other people who've been in the ICU experience the same thoughts and problems - that somebody understands them and knows they can get better."

When the project began in 2009, its purpose was to examine 90-day mortality of patients at five intensive care units in Lima, and how it correlated with clinical management, particularly protocols of mechanical ventilation. That aspect of the study continues, but grew to include long-term morbidity outcomes beyond the six-month period, Shams said.

In addition to learning more about how to conduct research, Shams also passed on knowledge to his Peruvian colleagues, including training two nurses to use sophisticated machines to measure lung function.

"Navid has been an asset to our Peru-based project, and has brought an important perspective into our research," Checkley said. "More importantly, Navid has identified potentially intervenable mental and physical health problems in patients receiving critical care."

Shams, who immigrated to the U.S. from Iran with his parents, has long been fascinated by different cultures and their attitudes toward public health and medicine.

After obtaining a master's in international health and epidemiology at Boston University in 2009, he conducted clinical field work on Chagas disease in Bolivia. After his fellowship in Peru, he returned to New York Medical College for his fourth year of studies.

His experience as a Fulbright-Fogarty Fellow has caused Shams to reconsider his career options. "Spending so much time with these patients made me really love clinical work. I'd like to go for a mix - continue the research, which I enjoy, but also have time for patient care."

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