Jack Underschultz

Supervisor: Michael Hawkes

Project: Biomarkers of global child pneumonia

Degree program:

Medicine & Dentistry-Pediatrics

Lay abstract:

Pneumonia is the most common cause of childhood deaths in the world today. Most deaths occur in Asia and Africa, but pneumonia is also a common reason that children in Canada are admitted to hospital. Getting the diagnosis correct is important because untreated pneumonia can be a fatal illness, and unnecessary use of antibiotics can fuel the spread of resistant bacteria. Doctors usually use a chest x-ray to make a diagnosis of pneumonia before giving antibiotic treatment. However, chest x-rays are not available in some resource-limited areas of the world. Moreover, chest x-rays expose children to radiation. We are proposing to study new ways of diagnosing pneumonia, using proteins ('biomarkers') that can be measured in a blood sample. We have discovered some lead biomarkers that are associated with childhood pneumonia. Our objective now is to validate these biomarkers is a large group of children with pneumonia around the world. We enrolled children with suspected pneumonia from two pediatric hospitals in Uganda. Children were tested with a chest x-ray and a blood test at the same time. We will now measure a panel of biomarkers in their blood and compare biomarker levels in children with pneumonia to those without. Biomarkers that are strongly associated with pneumonia could be used as clues for doctors to diagnose pneumonia when a chest x-ray is not available. Our vision is to find and validate biomarkers that could be adapted to a bedside test for pneumonia that could be used in clinics or emergency departments in Canada, or in areas of the world where there is no chest x-ray available. A finger prick blood test to replace the chest x-ray for pneumonia diagnosis would be a useful tool that could improve outcomes through better recognition of pneumonia, as well as reduce unnecessary antibiotic use in children who do not have pneumonia.

What motivated you to participate in this research?

I’ve a huge passion for medicine and international development. Working toward developing a point-of-care pneumonia diagnostic test combines both, which is very exciting to me. Having spent a month in a resource-limited hospital in Uganda, I saw first-hand the incredible impact a diagnostic test like this could have. Suspected pneumonia was the number one cause of admission on the pediatric ward but chest x-rays were not considered for almost all cases because of cost constraints. This test would not only help decipher the severity of the respiratory illness but also dictate whether antibiotic administration is necessary. When in doubt, all children received antibiotics so this test would reduce the unnecessary increase in antibiotic resistance. The benefits are vast in Canada, as well, as this test would allow ER physicians to diagnose pneumonia without having to expose children to potentially harmful radiation from chest x-rays. Point-of-care diagnostics is an area of research that excites me as a whole. The potential to replace expensive, time-consuming tests with equally effective but cheap and quick tests at the bedside table is a huge opportunity in medicine. There are many benefits but the more efficient use of scarce resources is the most important in my opinion. Time is a resource that is highly undervalued in the medical setting. The saving of time and money can now be spent on other patients who will boost the overall care delivered in health centers. What cannot be understated in my motivation is learning from an experienced and world-class researcher, Michael Hawkes. He is a leader in the field of pediatric infectious disease and I’m very excited to learn from his vast knowledge in the subject area. Additionally, I’m excited to improve my research skills and have already noticed a marked improvement since I began my project. I want to continue to learn how to construct and manage large scale research projects while innovatively thinking of new ones.

What are your career aspirations?

My career goal is to work on international projects in pediatric infectious disease and public health. International development has always been my passion and I'm very excited follow it in the field of healthcare. I’ve spent a lot of time in developing countries working on a wide variety of projects. While I strongly believe they were all equally important, I realized that experts on a given field are what are really needed to make a large difference. The potential to be an expert in global health is what I'm most enthusiastic for in my future. No matter what the field, experts are required to push the frontier. I want to be an innovator and constantly be on the frontier of improving opportunities and security in healthcare abroad. I've noticed the impact my supervisor, Hawkes, has had in hospitals across Eastern Africa which is something I want to emulate. Being able to innovate a medical technology so it’s able to reach millions more and save many more lives is something I find very rewarding. I also like the idea of collaborating with healthcare professionals from across the world. I learned a lot from physicians in Uganda, not only regarding medical knowledge and skills, but about how to approach investigations and management with limited resources. These lessons in the stewardship of resources are something I will hold tight during my education and future practice as it has the potential to alleviate many issues in the healthcare setting. In the long-term future, I would like to teach medical skills in developing countries. My plan is to establish a partnership with different hospitals across the world to facilitate an exchange of young physicians so each can learn what the other country has to offer, as well as pass on their own medical expertise. It would also allow for an appreciation of the differing medical issues facing countries with a goal of increasing global collaboration in medicine. I also think it would go a long way in appreciating cultural differences across the world and teach physicians how to best respect and incorporate a patient's culture in their care.

How has this studentship helped you toward those aspirations?

This studentship has proved invaluable in allowing me to enter the medical research field and start pursuing my career goals. Working with Hawkes on a point-of-care pneumonia diagnostic test has taught me a tremendous amount in the field of pneumonia and its vast impact internationally. It has also stimulated my mind to think of ways I can be innovative in the field of diagnostics and preventative measures for infectious disease. Overall, I feel like I’m starting to become a member of the pediatric infectious disease and global health community. I’ve improved my knowledge of how the body systemically responds to disease and how this allows us to detect diseases using blood samples. Additionally, I now see a great potential for detecting other diseases that currently are time consuming, expensive or labour intensive. Furthermore, I’ve built on my foundation of research skills and critical thinking that I will carry on for future projects. Having the support from WCHRI also gave me the financial freedom this summer to spend one month on a medical elective in rural Uganda. Gaining experience in an international, resource-limited hospital was invaluable for my career goals. Additionally, witnessing how difficult decisions were made that balanced resource constraints and patient health was a great learning experience that I will carry forward. Overall, I would like to thank WCHRI again for this amazing opportunity. It is much appreciated and has greatly enhanced my education and career potential.

Biomedical Global Health Research Network supported studentship