Author: Laura Bowen
Though many students go abroad with the intent of exploring an exotic locale, Lisa Bullard (sophomore) journeyed to Brazil this summer with a different goal in mind: medical research. With a Richter-ASP Grant in hand, Bullard spent three weeks in the South American country studying bone marrow transplant recipients and the quality of post-transplant life.
She researched at the University Of São Paulo Hospital das Clinicas in Riberão Preto, a public hospital that takes in many impoverished and uneducated patients. The specialized facilities in the hospital for these bone marrow transplants have been in development for around fifteen years, and are very sparsely located throughout the rest of the country. Because of this, people come in from all over Brazil to receive treatment at this specific hospital.
“[The bone marrow transplant] is a very specialized procedure that has only recently been available in Brazil,” Bullard said. “I wanted to see how that works and how that affects people and how they benefit from it as far as survival.”
Bullard received the grant after applying through Oxy’s Undergraduate Research Center, and due to the terms of the grant she had to construct most of the logistics herself. “You have to figure out everything on your own,” she said. Brazil made for a natural choice because she had family and friends with whom she could stay. “I had connections there,” she said. Her potential psychology major and desire to be pre-med also influenced the type of work she chose to do.
Five days a week, Bullard shadowed doctors, psychiatrists, occupational therapists and nutritionists. “I observed some of the patients,” she said. “[I would] always be there for rounds.”Bullard conducted interviews as well. “I interviewed about twenty people, [including] the providers . . . a whole team of professionals that work with the patients,” she said. The recovering patients often also had group activities, such as arts and crafts, that Bullard took part in.
Bullard came to the Portuguese-speaking country with minimal experience in the native language, but she managed despite the difficulties. “I was able to get by,” she said. She communicated with non-English speakers by developing a small vocabulary.
The public hospital receives limited funding, which restricts the amount of modern technology available. Bullard admitted that the equipment was somewhat “primitive.”
However, the transplant unit has been around for several years, and Bullard said the workers had figured out ways to get what they needed. Further, the hospital’s patients have generally more success than patients of some of the private facilities. “The survival rate is within 50 percent,” Bullard said. “This unit is much better than other units in the hospital – it has a really strong team, and patients do receive good care.”
Bone marrow transplants are, in Bullard’s words, “a last resort for leukemia.” As a public hospital, it provides for the under-served population, especially those in need of public healthcare. However, the waiting lines for transplants are still very long and have strict criteria. The ages of the patients vary, and Bullard encountered a patient who was just seven years old. “He had been in and out of there for four years,” she said.
Bullard’s research led her to find out several factors that affected the quality of life of patients post-transplant. Going through the transplant process, the patients deal with “a ton of restrictions . . . [such as] dietary, medication,” Bullard said.
The health background of the patients had a major impact on how well they responded to treatment. This was especially crucial due to the potential of “all kinds of complications” post-transplant, she said.
The quality of life for patients suffers after the bone marrow transplant for a variety of reasons. “The patients are very physically weak,” she said. “Their immune systems are debilitated.”
Doctors restrict patients from eating fruits due to high levels of germ-content. Patients must also wear masks to protect themselves from germs, Bullard said.
Patients are also restricted from any sun exposure because the reaction triggers a negative immune response. “Going out in public is relatively stressful,” Bullard said.
The patients’ level of education proved important in the recovery process as well. “[The patient’s education helps them] to understand what they need to do,” she said.
Most patients stay at the facility for a month after their treatment, and then come back daily for two months following that to get their medication, check-ups, and so on. “For the more affluent patients, obviously this hospital is really bad, but for others this is the first time they’re getting dental care, the first time they’re having their nutrition getting looked at,” Bullard said.
“A lot of them worked on sugar fields in harsh conditions and didn’t have access to this.” Bullard noticed a lack of experience with health care in the most basic of tasks. “Some patients had to stay [longer] . . . they couldn’t read labels [on their medications],” Bullard said.
Visits from family members were also very important to recovering patients, Bullard discovered. “For all the people that I interviewed, there’s a noticeable difference between patients who can see their families regularly [and] those who can’t,” she said.
“Those that had a lot of family support [did better] . . . they had a stronger social network,” she said.
Money is a large factor that determined whether families could visit the patients more often. Because people often came from far away, many from the poverty-stricken North, it would be expensive and time-consuming to visit frequently. Overall, “money had a big influence,” Bullard said.
One characteristic that did not require money was having “religion, faith . . .[the transplant] is a really scary thing . . .they did better [and] were able to endure the difficulty,” Bullard said. Looking back, Bullard described her research in Brazil as, “awesome . . . it was a really great experience,” and something she would do again.
“It was a really great experience for me and kind of reinforced that I want to go into the health field,” she said. “I have a greater appreciation for what people go through, and the sensitivity of the doctors in a third world country of [facing] cancer and the difficulty to have to treat patients that are so sick and chronically ill.”
Given a research grant through Oxy, Bullard uncovered information about the lives of lower-income bone marrow transplant patients and the environment in which they struggle to survive.
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