Keeping track of AIDS treatment

A run-down, poorly equipped hospital; suffering, malnourished patients; eyes full of pain, desperation and hopelessness: These are the pictures many have seen of AIDS in Third World countries.

But for former UW nursing student Karin Huster, images are different. They not only serve as a tool for documentation, they can also help these distressed patients.

Huster, now a registered nurse at Harborview Medical Center, traveled to South Africa in the summer of 2004 under the Citizens of the World Scholar Award, a scholarship given by the UW School of Nursing that allows students the opportunity to work in health care in a culture different from their own.

"It's specifically set up so you get an experience abroad, but you have to figure out your own experience," Huster said.

Though she left the U.S. without a specific project idea in mind, Huster soon created a new tool based on her observations. The picture-based medication scheduler is a device that uses images to remind patients, especially families of patients, what medicine needs to be taken, at what time and by whom.

"I was working quite a lot with families," Huster said. "I could see it was really hard for them to juggle with their kids and not forget something."

Because very few patients at the clinics were able to read and write, Huster used pictograms so that all, even the illiterate, would be able to understand.

The language barrier can be a problem as well, said Susanna Cunningham, a professor of biobehavioral nursing and health systems as well as Huster's honors adviser.

"I think literacy is an issue, and cross-cultural communication is an issue and anything you can do to help is a step in the right direction," she said.

However, the picture scheduler can also address the needs of literate patients. It's a device that could be used at Bartell Drugs in place of handing out pamphlets, Huster explained.

The goal of the project was to provide a simpler way to explain medication usage.

"It's not that illiterate people don't take their meds," Huster said. "It seemed to be a really simple way of remembering when to take something with what and how to store it."

At the clinics, Huster encountered many grandparents caring for young children with AIDS, often because the parents had died or left. Managing medication for their grandkids was difficult, she said.

There are a variety of medications used to fight HIV. According to thebody.com, an informational Web site for HIV and AIDS, 25 HIV medications have been approved by the U.S. government and many more are being developed. These are organized by class, with each group attacking HIV in a different way. In order to be most effective, a regimen is created using drugs from distinct classes.

"That cocktail of drugs can differ significantly from one patient to another, so a doctor needs flexibility for describing the prescription," said Richard Banks, a former co-worker of Huster's and an aide on the project. "The scheduler provides a very simple way for doctors to customize the prescription, adjusting dosage and time, per patient."

Taking HIV medication consistently is vital to its effectiveness.

"It's awful with HIV because if you're less than 95 percent adherent to the medication, you might as well stop taking it," Huster said. "You must take pills all the time and even if you forget twice a month you can really screw yourself up."

Before studying to become a nurse at the UW, Huster worked at Microsoft as a program manager for 11 years. She had always liked medicine and began volunteering at Harborview during her last two years at Microsoft. Ready to do something different, she traded in her work in technology for a position in the medical field and enrolled in the UW School of Nursing.

Yet Huster's technical background became useful when she was able to call on Banks, her former Microsoft co-worker, to help design the scheduler.

"I worked with her on a number of graphic design mock-ups, looking at different ways of visualizing all the scheduling information that the project would need to represent and then generated a 'final design' for her," he said.

The invention soon came in handy for furthering Huster's career in medicine. She now has an internship with PATH, an international non-profit organization that works toward improving global health.

"Her South Africa work resonated with me as conveying complex information to populations with varying levels of literacy," said Matt Steele, a diagnostics program officer and Huster's advisor. "Understanding of health practices is a constant problem in all of the projects I work on here at PATH."

Huster is now working on a field-evaluation program for a method of diagnosing tuberculosis that PATH may carry out in Ukraine. She aids both design and implementation for study protocols that guide collection data in the field.

"That's the direction I really want to head towards," she said. "I like to work with patients, but then apply it to a bigger population."

Huster chose South Africa because she was born on Reunion Island near Madagascar. She liked the country and was moved by the high number of AIDS patients in the area.

"I was attracted to the illness just because there's so many people who have it and in the poorest countries in the world," Huster said.

Huster enjoys traveling and hopes to continue working in medicine abroad. Yet she recognizes that some technology isn't always applicable, especially in developing countries where resources may not be available.

"We have to be careful to not use technology for everything because it's not always going to be the right thing to do," she said. "With some stuff, you still need plain human contact and just basic education."

Reach reporter Meghan Peters at features@thedaily.washington.edu.