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Fogarty Fellow investigates trauma care in Tanzania
September/October 2021 Volume 20 Number 5
Rapid urbanization in many low- and middle-income countries (LMICs) is resulting in a growing number of trauma injuries due to traffic accidents. Shin bone fractures are the most common broken bones globally and have a high infection rate, up to 40%. There are currently two common ways to treat the fractures surgically— placing a nail or plate internally to stabilize the bone or fixing it externally with pins and rods. While external fixation is far less invasive, it requires a much longer healing time, which is difficult for working patients whose jobs require mobility.
Fogarty Fellow Dr. Abigail Cortez spent a year studying surgical outcomes of patients with tibia fractures in Tanzania to see which treatment method had better results. Cortez, now an orthopedic surgery resident at the University of California, Los Angeles, was forced to work remotely from her home base due to the COVID-19 pandemic. She relied heavily on her team of research coordinators in Tanzania. They followed up with about 240 patients who were offered in-person appointments, which involved x-rays and a clinical assessment, or a phone consultation. To work around COVID restrictions, the research team developed a detailed questionnaire to try and elicit the same level of information, even though they couldn’t physically be with the patient.
Her study found that there are no fundamental differences between the two surgical approaches, even two to five years after the initial surgery. This proved that the internally applied nail did not cause higher rates of infection and is a viable alternative to external fixation, which is often preferred in LMICs. Eight of the patients reported persistent or complex complications after their surgery, and these patients were seen to have overall lower quality of life. Four of them had received the internal nail, and four had received external fixation. The quality-of-life scores they shared were comparable to some chronic illnesses, which highlighted the importance of complication and infection prevention and continuity of care.
“We should be focusing on how best to prevent infection prior to surgery so that we can avoid the burden of those complications after surgery,” said Cortez. “Chronic complications will ultimately cost a lot more to the healthcare system, and this is true in both low- and high-income countries.”
During her fellowship, Cortez trained in biostatistics and learned how to work with online data capturing tools, in addition to practicing fundamentals such as study design and manuscript writing. “This was a very impactful year and I gained a lot of tools in my research toolbox,” she said. “Now, I feel a lot more confident conducting research independently, and I think it's only going to help my career.”
“During this process, you realize how long research takes, from the inception of an idea, testing your hypothesis, formulating your study design and nailing down the logistics for implementation,” Cortz observed. She recently helped develop two projects that allowed her to employ the skills she learned during her Fogarty experience. One will examine amputation and the impact of prosthetic devices in LMICs and the second will study post-surgical infection rates.
“I feel like my life has changed for the better because of the Fogarty fellowship. I learned so much, and I also made so many valuable connections,” she said. “The global health community is a close one. Now I know that if I have any questions or any new research interests, I know who to contact, and I’ll be able to find the right person in any country.”
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