Pulmonary Critical Care Global Health Program

Overview

Given the substantial burden of respiratory and critical illness worldwide and increased globalization, the Division of Pulmonary Disease and Critical Care Medicine at VCU is dedicated to research and capacity building not just in our community but globally. 

The VCU - Pulmonary Critical Care Global Health Program has ongoing projects in Rwanda as well as Uganda and we have affiliations with other departments at VCU who work throughout Central and South America. Our faculty have obtained external grant funding to support research in East Africa and have published their work and presented at meetings internationally. Perhaps even more important, through support from the VCU - Department of Internal Medicine, our team has fostered bi-directional exchange with our colleagues in Rwanda, which allows our division to learn from their expertise.  

While the COVID19 pandemic has created challenges within global health it has also provided opportunities, both for research, and new solutions like telemedicine to support our colleagues abroad.  

Implementation of a Bronchoscopy Program in Kampala, Uganda

Uganda Bronchoscopy and Pleural Program (UBP) [View Image]During his time at Johns Hopkins, Dr. Jackson worked alongside his colleagues Dr. Trishul Siddharthan and Dr. Hans Lee to establish the Uganda Bronchoscopy and Pleural Program (UBP) in 2019. The UBP provided equipment through donation and support from the Chest Foundation Community Service Grant and trained Ugandan clinicians to create the first public bronchoscopy program in Uganda at the Makerere Lung Institute. In Uganda, a country of 40 million people, this new technology allows for better diagnosis of respiratory disease and provides training for a future generation of pulmonary specialists. Dr. Jackson continues to conduct research on the implementation of this program and supports this project through ongoing training and education.

Investigating the Effect of the COVID19 Pandemic on Tuberculosis Care in Uganda

Lung Institute [View Image]Dr. Jackson, along with Dr. Hopkinson and their colleagues at the Makerere University Infectious Disease Institute in Kampala, Uganda were recipients of the first Chest Foundation & American Thoracic Society Grant in COVID and Diversity. Recent research predicted that the COVID-19 pandemic will indirectly result in an estimated 6.3 million excess cases and 1.3 million excess deaths from TB globally with the majority occurring in Africa and other LMICs [low and middle-income countries]. Given the toll that COVID-19 will have on TB care Dr. Jackson and the VCU PCCM Global Health team are conducting a study to determine how best to minimize the impact of COVID-19 on Tuberculosis care in Uganda.

Investigating Interstitial and Restrictive Lung Disease in sub-Saharan Africa

lung image [View Image]Interstitial lung disease (ILD) is a group of pulmonary disorders that are characterized by similar clinical, radiographic, and pathologic criteria. They can be caused by underlying disease or in some cases exposures that can cause inflammation and scarring in the lung. There is little data on the epidemiology of ILD in developing countries, especially in sub- Saharan Africa (sSA). Studies describing ILD in other low-middle-income countries, have shown marked differences from registries in Europe and the USA. Given that non-communicable respiratory disease is a growing global health threat and the high rates of pollution and occupational exposures in sSA it is important to characterize ILD within this region.  The Global Health Team and VCU-PCCM has several projects to investigate ILD in sSA. We have developed and validated a questionnaire to assist clinicians in East Africa when they see patients with suspected ILD and two of our PCCM fellows have begun a project using telemedicine conferences to discuss cases with our international colleagues.  In addition, through support from the Fogarty Center at the NIH, we are conducting a project using CT scans to look for ILD in a large cohort of patients with abnormal breathing tests in Uganda.

Sepsis and Septic Shock in Rwanda

rwanda [View Image]Drs. Hopkinson and Syed, Dr. Beth Riviello at Harvard Medical School, and their colleagues at University of Rwanda College of Medicine and Health Sciences are working to obtain a better understanding of sepsis in Rwanda, ultimately in order to improve outcomes. We first performed a retrospective cohort study on the presentation, management, outcomes, and predictors of mortality of sepsis in two of Rwanda’s tertiary referral centers. We found that sepsis and septic shock mortality are high at these centers (51.4% and 82.9%, respectively), most patients received intravenous fluids and antimicrobials, and baseline characteristic mortality predictors were respiratory rate, Glasgow Coma Scale score, and known HIV seropositivity. Currently, we are working to understand how delays in care at the care seeking and care receiving levels may impact outcomes from sepsis. 

High-dose intravenous vitamin C as an adjunctive treatment for sepsis in Rwanda: a feasibility trial

rwanda [View Image]As described above in our work on sepsis in Rwanda, mortality from sepsis and septic shock is high. High-dose intravenous vitamin C when used as an adjunct has been shown to reduce mortality in sepsis; moreover, it is relatively inexpensive and may be of even greater benefit in a population with baseline nutrient deficiencies. Thus, Drs. Hopkinson, Syed, and Jackson are working with our colleagues at University of Rwanda College of Medicine and Health Sciences, Dr. Jennifer Rickard (University of Minnesota and University of Rwanda), and Dr. Beth Riviello at Harvard Medical School to perform the first randomized controlled trial of high-dose intravenous vitamin C in a low-income country. We are first conducting a feasibility trial in 24 patients with plans to expand to a larger set of subjects pending the results of the feasibility trial. The trial is listed on clinicaltrials.gov.

Fundamentals of Critical Care Support (FCCS) in Rwanda

fccs image [View Image]The FCCS course developed by the Society of Critical Care Medicine (SCCM) is widely used in the United States and provides health care professionals with an overview of various aspects of Critical Care. Internationally there is a tremendous need for such education in Low and Middle Income countries. With the support of the SCCM we have been conducting yearly courses in Rwanda with the goal of developing local instructors as well developing a course that is specifically tailored to the local environment.

Guideline-based performance assessment in the Rwandan intensive care unit-informing the development of future evidenced-based educational intervention

After teaching the Society of Critical Care Medicine’s Fundamental Critical Care Support (FCCS) in 2018 and in 2019 in Kigali, Drs. Hopkinson, Syed, and Boateng and our colleagues at University of Rwanda College of Medicine and Health Sciences realized the need and desire for a course that fits the needs more specifically of Rwandan critical care providers. Thus, we have embarked upon a study in which we aim determine the rate of performance of critical care management guidelines / best practices in the Rwandan ICU, to assess the epidemiology of patients admitted to the intensive care unit to determine what disease states and complications are encountered most frequently by healthcare provider, and to evaluate the material and personnel resources available for delivery of critical care services. We are working to commence this prospective observational study in all four ICUs in Rwanda. The guidelines to be assessed were determined through a modified Delphi process involving subject matter experts in the U.S., Rwanda, and South Africa.

Guideline-based performance assessment in the Rwandan intensive care unit informing the development of future evidenced-based educational intervention

After teaching the Society of Critical Care Medicine’s Fundamental Critical Care Support (FCCS) in Rwanda, Drs. Hopkinson, Syed, and Boateng and our colleagues at University of Rwanda College of Medicine and Health Sciences realized the need and desire for a course that fits the needs more specifically of Rwandan critical care providers. Thus, we have embarked upon a study in which we aim determine the rate of performance of critical care management guidelines / best practices in the Rwandan ICU, to assess the epidemiology of patients admitted to the intensive care unit to determine what disease states and complications are encountered most frequently by healthcare provider, and to evaluate the material and personnel resources available for delivery of critical care services. We are working to commence this prospective observational study in all four ICUs in Rwanda. The guidelines to be assessed were determined through a modified Delphi process involving subject matter experts in the U.S., Rwanda, and South Africa.

Clinical Exposure Program for Rwandan Physician Trainees

In collaboration with the University of Virginia, the VCU Global Health Team has supported two Rwandan physician trainees every year for one month rotations in various Intensive Care Units at VCU. This involves joining rounds and attending lectures with a requirement to complete a small project at the end of the rotation. This program has proved to be invaluable in providing much needed clinical experience and exposure the Rwandan Trainees. We hope to continue to expand this program to a bi-direction program. 

Our Research Publications

Uganda


countrysideUganda [View Image]
, known as “the Pearl of Africa” is a relatively small country of approximately 43 million people in East Africa. Like many countries in sub-Saharan Africa there is an emerging convergence of communicable and non-communicable pulmonary disease challenging the health care system. Uganda is amongst the 30 countries with the highest rates of TB and HIV co-infection in the world but also has high rates of COPD, Asthma and restrictive lung disease. These challenges are being met with research from the VCU-PCCM Global Health Team and our partners at the Makerere University College of Health Sciences Lung Institute and Infectious Disease Institute.

 

Rwanda


Rwanda [View Image]The “Land of a Thousand Hills” is the moniker given to the Republic of Rwanda, a small country in East Africa with a population of approximately twelve million. This land-locked country is known for its mountain gorillas, coffee, tea, and beautiful landscapes. Since the genocide against the Tutsi in 1994, Rwanda has seen notable economic, social, and public health gains. Critical care occurs in four tertiary referral (teaching) hospitals – three in Kigali and one in the Southern Province of Butare. ICU mortality has been shown to be high, with a recent study indicating a mortality rate of 48.7%. We are working with colleagues at the University of Rwanda College of Medicine and Health Sciences to better understand critical care in Rwanda and to improve critical care education and outcomes.

Peter Jackson, MD [View Image]

Peter Jackson, MD

Assistant Professor & Co-Director

Peter Jackson, MD [View Image]

Peter Jackson, MD

Assistant Professor & Co-Director

Internal Medicine

Division of Pulmonary Disease and Critical Care Medicine

Fax: (804) 828-9071

Email: peter.jackson@vcuhealth.org

Address/Location:
Box 980049
Richmond, VA 23298

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Aamer A. Syed, MD, ME [View Image]

Aamer A. Syed, MD, ME

Assistant Professor & Co-Director

Aamer A. Syed, MD, ME [View Image]

Aamer A. Syed, MD, ME

Assistant Professor & Co-Director

Internal Medicine

Division of Pulmonary Disease and Critical Care Medicine

Phone: (804) 828-9071

Email: aamer.syed@vcuhealth.org

Address/Location:
Box 980050
Richmond, VA 23298

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View Faculty Expertise Profile

Dennis A. Hopkinson, MD [View Image]

Dennis A. Hopkinson, MD

Instructor & Rising Scholar

Dennis A. Hopkinson, MD [View Image]

Dennis A. Hopkinson, MD

Instructor & Rising Scholar

Internal Medicine

Division of Hospital Medicine

Phone: (804) 828-3144

Email: dennis.hopkinson@vcuhealth.org

Address/Location:
Box 980102
Richmond, VA 23298

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The VCU Pulmonary Critical Care Global Health Program has received support from internal and external grants to support their projects. This support includes NIH funding from the Fogarty Center, external funding from the American Thoracic Society and Chest Foundation, and internal funding from the Department of Internal Medicine and VCU.

If you are interested in supporting our work, please contact us using the information below.

Please contact the VCU - Pulmonary Critical Care Global Health Program:


Co-Directors:

Peter Jackson, MD
Department of Internal Medicine
Division of Pulmonary Disease and Critical Care Medicine
Box 980049
Phone: (804) 828-9071
Email: peter.jackson@vcuhealth.org

Aamer Syed, MD
Department of Internal Medicine
Division of Pulmonary Disease and Critical Care Medicine
Box 980050
Phone: (804) 828-9071
Email: aamer.syed@vcuhealth.org

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