For the first time since our existence, we are hosting a Research Nurse! Lungile, from THINK, is here to tell us about the ethics, safety, and quality of work needed in carrying out clinical research studies;
Hi Lungile, thank you for joining us today. I am excited to learn about clinical trials and what exactly a Research Nurse does
Hi Winnie. Thanks for inviting me here. I am excited to share my experience in the health sector.
Would you mind sharing a little bit about yourself?
My name is Lungile Phakathi, from Durban, South Africa. I am a Clinical Research Nurse at THINK.
What does a normal day look like for a Research Nurse at THINK?
A Research Nurse is different from a normal nurse in a hospital or clinic. What we do here is clinical research, which involves recruiting patients that participate in our MDR TB clinical trials. Our main focus was to try and shorten the duration of the MDR treatment which was initially 18 to 24 months. Through our research at THINK, we have managed to change the South African guidelines to reduce the duration of MDR treatments to 9 months.
On a normal day, research and field nurses go out of the clinic and recruit MDR patients, with the help of clinic and TB nurses. A consent form is signed after a clear explanation of what the studies are about. These become our patients throughout their MDR treatment. We work with teams of medical people like doctors and pharmacists during the studies.
The procedures in clinical trials are more intense than those in a normal clinic. This is because some of the medicine given during clinical trials is not yet approved by the government. So, we have to do routine blood checks to test the side effects these medicines might have on our patients. It’s almost like a day-to-day running of a clinic but doing specific procedures.
I have been working on a pediatric trial called the Janssen Pediatric Trial which started in 2015. This trial was also to shorten the pediatric treatment for kids that have MDR and minimize the side effects of the treatment. It’s more intense when dealing with kids because they are still fragile and need extra care. We collect blood and take x-rays, but the hardest task is collecting sputum from kids. Gastric aspiration is the only way we can collect that sputum since this is the only way we can detect if the child is getting better.
Another task is to observe and monitor if the patient is taking the medication, whether they are in or out of the hospital. It’s not possible to run a clinical trial if the patient is defaulting. Those will not be correct results.
Thinking about your childhood, what drove your passion to become a Research Nurse?
I have always been affectionate about helping people – I have a soft spot for wanting to make a difference. It makes me very happy when I can help someone and they say “thank you”. This is my main reason for wanting to become a Research Nurse.
However, my main push for the health sector started when I lost my brother to TB in 2007. I still believe he could have gotten better help but it was those bad days of hard treatment for HIV and TB. At the time of his death, he had just been considered for an appointment to start attending ARV classes. From then I decided that even if I make a difference for one person, it would mean a lot to me.
After his death, I joined St. Mary’s Hospital for a course in nursing because I wanted to make a difference. Luckily, I was employed in the TB clinic after school. While there, a team from THINK’s clinical research department came in to use the gene express machine to check the sputum. For a long time, it was only possible to receive sputum results after 6 weeks to 2 months. By then, most patients were already dead! This machine was a solution to get results in less than 48 hours.
I was fascinated by what they were doing and asked a lot of questions. My curiosity made them ask me if I wanted to join research and I accepted. When the opportunity arose, I was asked to apply and that is how I got into THINK. I moved from the department of health, into clinical research.
Lungile, what has been the most challenging moment for you as a Research Nurse?
I am lucky to work in a place like THINK – we have got all the necessary equipment for the work we do. However, through our work, we need to interact with people in the field and government facilities. Sometimes you walk into a 4-bed ward, full of patients with Hypertension but the BP machine is not working, yet you are on night duty! In such cases, you can’t call any technician to help out. At 4 am, the patient dies and now you live with the question, “maybe there is something I could have done if only I was able to check the bp!”. My biggest challenges working in such places are the lack of facilities and the shortage of staff.
We join these fields with a passion so big that we are willing to go beyond our scope of job designation. But, sometimes things are beyond our control.
Aside from being in a conducive working environment, how else are you inspired to continue doing your job irrespective of the challenges around you?
THINK teaches us to be very professional in what we do. As mentioned earlier, our work at THINK involves interacting with people from different parts of the country. Sometimes the situation we find in the homes we visit breaks us! The only way out is for us to be as professional as we can. Maybe we can seek help on behalf of the homes through social workers or home affairs.
What would you like to teach our audience about infectious diseases like HIV and TB in Africa?
I will talk about HIV first. It is transmitted through unprotected sex, mother-child transmission, and blood-to-blood transfusions. No one should lie to you that HIV can be spread through hugging, sharing utensils, or sitting next to an infected person. We know that HIV can’t be cured at the moment but it can be managed through taking proper treatment.
HIV-positive mothers can now give birth to HIV-negative babies. Prevention of mother-to-child transmission (PMTCT) has been going on for a long time and is showing good results. Mothers only have to go to the clinic early enough and follow all rules given to them while pregnant. Also, HIV-positive mothers can now breastfeed. This is a very good thing because you can’t expect an unemployed mother to buy formula for her baby’s survival. If the mother takes her treatment very well and the viral load is suppressed, that mother can breastfeed very well.
TB is an airborne disease that spreads through coughing. Among measures taken to prevent the spread of TB, we always preach about ventilation in taxes, community halls, churches, and other public places. Initially, the earliest symptom of TB was coughing for more than 2 weeks but now, if anyone coughs constantly for more than 2 days, they should be tested for TB. TB is curable and early detection in patients is one of the major ways TB can be fought.
What we are fighting most in the TB-infected community is the rate of default. Treatment takes a long time – 6 months for normal treatment and 9 months for MDR but, once followed, the person will cure completely. Most people default because of poverty – they can’t take medicine without food in their stomachs. Another reason is the side effects of the medicine. That is why we run clinical trials. We are trying to get treatment with fewer side effects to increase the number of patient retention.
What has been your most prestigious moment at THINK so far?
It’s been a lot of wonderful moments since I have been here for almost 10 years. One of those moments was the announcement that one of our clinical research works had been able to change the South African government health guidelines from 18-24 months of treatment to 9 months. The earlier months required patients to get daily treatments which were making patients go deaf. We have succeeded in taking out that side effect and reducing the treatment duration. I felt like I had been part of a huge success in a field I am very passionate about.
Who are you outside of THINK walls and the Research Nurse umbrella?
I am a mother of 2 boys and an only child (because my brother passed away) to my mother. Mainly, I would say I am a family person because I spend most of my free time at home with my mother. I wouldn’t call myself an outdoor person.
What is your favorite quote?
“Do what you love and you will never have to work a day in your life” ~ Confucius. With the current economic advancements, you can turn your passion into anything lucrative. I always tell people that nursing is not only about injecting people. We have a variety of nursing fields out there. For example, some nurses authorize our insurance claims from the comfort of their computers. Some nurses work for road accident funds – they grade injuries and determine how much people should get.
What piece of advice would you give a young African girl who wants to become a Research Nurse?
I would tell them to never give up and work as hard and as smart as they can. To refer to my story, I came to THINK as an Enrolled Nurse. Being a long-time employer, I ended up training people who were more qualified than me. Fortunately for me, I know how to seize opportunities once they present themselves. I went back to school and qualified as a Registered Nurse, which led to my current position as a Research Nurse. It wasn’t an easy time because I had work and school plus practicals to perform.
What I can say to young Lungile is that she has to stay focused and train for the future. Don’t overwork yourself because your mental health is the most important thing for you and your family.
Thank you very much, Lungile, for accepting to teach us about what a Research Nurse does and everything we didn’t know about infectious diseases. We look forward to learning more about THINK’s work in the health sector.