Pediatric nephrologist Erica Christen Bjornstad, M.D., Ph.D., MPH, has been working inglobal health since college. As a Peace Corps volunteer she served as a rural public health volunteer in Ecuador, and in the years after brought her public health expertise to Peru, Afghanistan, Malawi, and Tanzania. In fact, it was her work with trauma surgeons in Malawi, one of the five poorest countries in the world, during her fellowship at the University of North Carolina-Chapel Hill that stoked her interest in acute kidney injury (AKI).
The condition is a significant cause of morbidity and mortality in the post-surgical and ICU setting and is typically diagnosed late in the disease state when severe kidney damage may have already occurred. In poor countries like Malawi, which don’t have the infrastructure required to obtain and run laboratory blood tests, the diagnosis may never come. Patients then develop end-stage renal failure but have little, if any, access to dialysis.
During her fellowship, Bjornstad brought a point-of-care urine dipstick test to Malawi to provide instant results on kidney function. Now at Children’s of Alabama, she hopes to bring that test – and her deep knowledge of the unmet nephrology needs in developing countries— to Zambia through the hospital’s existing relationship with the Centre for Infectious Disease Research in Zambia (CIDRZ). “Zambia is better off than Malawi,” she said, “but still struggles with a lot of scarcities and lab shortages.” COVID-19 has exacerbated those problems exponentially, she said. “Having a point-of-care test would be quite valuable.”
Such partnerships are what enticed her to Children’s in 2019 when she finished her fellowship. It was important, she said, that the pediatrics department at the University of Alabama Birmingham (UAB) wants to build its global health presence in a sustainable way, “not popping in and popping out.”
That means providing the education and support to work alongside a developing country improving its own medical infrastructure. The people who live in the country “are 100 times more prepared to ask the right questions and provide potential solutions that we never would have thought of,” she said, “because they are there and they know what works and what doesn’t.”
The relationships we build with these institutions, if done right, can lead to great changes in both,” she said. “But we have to be careful that it is done in a thoughtful way and that the U.S. side is not doing all the benefitting.” The CIDRZ/UAB partnership, she said, exemplifies sustainability.
But there needs to be more focus on kidney disease. “The need for nephrology is underappreciated and often overlooked in global health until there is a very dire medical emergency,” she said. So finding ways to bring the specialty to areas with few resources – as with a dipstick – is critical. “I can’t take a lab machine on the plane with me,” she said. “But if I can throw some dipsticks in my pack and diagnose AKI, that could be revolutionary.”