By Tapela Morapedi
The mere mention of the words, Lumbar Puncture (LP) literally sends chills down one’s spine, but this dreaded medical procedure is indeed a lifesaving one than the life-ending procedure it has been publicly portrayed by the society. The Botswana Harvard AIDS Institute Partnership (BHP) is spearheading a drive to engage the general public in research by hosting a series of workshops aimed at demystifying medical topics deemed controversial.
The first of this series was a meeting event on “The Lumbar Puncture” held at the BHP conference room on the 2ndof November 2019. The main objective was aimed at educating about the LP and spreading the positive message that receiving a lumbar puncture is not a death sentence but rather a lifesaving procedure that allow doctors to rapidly diagnose and treat patients with meningitis. The Lumbar puncture workshop, was organized by Dr Nabila Youssouf, Clinical Trials Manager for the AMBITION Study, the BHP Community Engagement and Communications Team, and was funded by the London School of Hygiene and Tropical Medicine and the National Institute for Health Research.
The AMBITION study led by Professor Joe Jarvis is a multi site study conducted in 5 Countries (Republic of South Africa, Malawi, Zimbabwe, Uganda and Botswana)funded by the EDCTP to investigate if a Short-course of high-dose Liposomal -Ambisome given with high dose fluconazole and flucytosine will be non-inferior to standard daily-dosed amphotericin B deoxycholate with flucytosine induction therapy for the treatment of HIV-associated cryptococcal meningitis in averting all-cause mortality.
Presenting at the workshop, Research Nurse, Katlego Tsholo explained that lumbar puncture is a procedure whereby a needle is inserted into the lumbar area of the spine and cerebro-sipinal fluid (CSF) withdrawn from the patient usually for diagnostic purposes . A video of the LP procedure was screened for the attendees to appreciate the process of the LP procedure as it was being carried out. She pointed out that LPs are now performed using smaller needles and patients receive local anaesthetic injection in advance to reduce pain and discomfort. LP equipment including the needles, were in display for appreciation by the workshop attendees.
The Research Nurse explained the two key purposes of the LP in the management of Cryptococcal Meningitis is 1) to reduce intra cranial pressure and the resultant headaches and risk of visual impairment and 2) collection of spinal CSF which is used for diagnosing Cryptococcal Meningitis (CM) which is done by testing for the presence of Cryptococcus, an opportunistic fungus in the CSF. She stressed that timely diagnosis, management of intracranial pressure and rapid treatment of infection are fundamental in the fight to reduce mortality associated with CM.
Despite the well well-known importance of performing timely lumbar punctures, they are under performed as patients often refuse to have them because of myths that LP’s cause death. Patients refuse until they become extremely sick only to agree to have the procedure done at the eleventh hour when it is already too late and patients end up dying from severe CM resulting in a false association between the procedure and death.
During her presentation, she stressed the point that the aim of the educational workshop was to change the views of the community on lumbar punctures thereby helping reduce mortality associated with Cryptococcal Meningitis in Botswana.
Attendees learnt that LP is the most efficient method of relieving the symptoms of increased intra cranial pressure associated with neurological infections and the most effective way of diagnosing CM. Nevertheless, the negative reputation of LP remains a great barrier to its implementation with many patients and their families refusing treatment.
The workshop was attended by the BHP Community Advisory Board (CAB) which is made up of people of different backgrounds including dikgosi (chiefs), community leaders and members of the clergy and other community based organizations. The workshop was also aimed at understanding why LPs acquired this negative reputation and to offer attendees objective knowledge on its risks and benefits so that they are able to go back to their communities and educate other community members. A patient who received LPs and experienced its benefits shared his experiences with the procedure, allaying the fears that LP is life-threatening as opposed to life saving.
The workshop attendees were taken on a guided tour of the Botswana Harvard HIV Refence Laboratory (BHHRL) to further appreciate LP process from bench to bedside.The next workshop titled “HIV Research: Searching for a cure” is already in preparation. The Community Engagement team hopes to deliver one workshop per month to help spread medical knowledge in the community and disprove harmful myths associated with medical procedures and medicine in general.