Fogarty Fellow Focuses on Fevers in Pediatric Cancer Patients
Fevers are common with many childhood illnesses, but for children with cancer, a fever can signal a potentially dangerous or fatal infection.
Determining the cause of these fevers and identifying ways to improve care in resource limited settings is the research focus for Nate Nessle, DO, during his Fogarty fellowship year at Moi Teaching and Referral Hospital (MTRH) in Kenya. He believes no child with cancer should die from a fever.
Dr. Nate Nessle
Dr. Nessle was selected for the 2022-23 Fogarty International Center’s Global Health Fellows and Scholars Program, now called Launching Future Leaders in Global Health (LAUNCH) Research Training Program. His research proposal is entitled “Understanding the barriers and facilitators of effective management of febrile (fever) episodes in pediatric cancer patients in Kenya: a mixed methods study.”
During the year, Dr. Nessle will be conducting interviews with healthcare providers while collecting data from inpatient pediatric cancer patients with fevers to meet his research aims and ultimately improve care.
“I love research, but I love patients more,” said Dr. Nessle. “The reason why I love research is because it helps me take care of patients better.”
Dr. Nessle’s research in Kenya builds on research he is involved with at the University of Michigan to best manage fever episodes in children with cancer. “I aspire to be a leader in supportive care measures focusing on febrile episodes and effective resource utilization in pediatric oncology in my local and global practice,” said Dr. Nessle. He intends to make a global pediatric oncology practice and clinical research a prominent part of his career and his family hopes to build home communities in both the US and in a low or middle-income country where he works.
“I really enjoy doing continuous quality improvement and implementation science studies like I’m doing now,” said Dr. Nessle. “You can see a problem, rigorously research it and come out at the end with an output that will immediately start to improve patient outcomes.”
Dr. Nessle received his Doctor of Osteopathic Medicine from Rocky Vista College of Osteopathic Medicine in 2015 and completed his residency at the University of Louisville. He then completed his pediatric hematology/oncology fellowship at the University of Michigan and arrived in Eldoret to begin his Fogarty year in September, 2022. Dr. Nessle was selected for the Fogarty opportunity through the Northern/Pacific Global Health (NPGH) Training Consortium which includes the University of Michigan, Indiana University and Moi University as partners. Dr. Nessle is in Eldoret with his wife Stephanie, a teacher, and three young children aged 8, 6 and 5.
Dr. Nessle’s mentor team includes: Terry Vik, MD, Indiana University School of Medicine; Festus Njuguna, MBChB, MMed., PhD, head of pediatric hematology-oncology department at Moi Teaching and Referral Hosptial and lecturer at Moi University School of Medicine; Gilbert Olbara, MBChB, MMed., of Moi Teaching and Referral Hospital; and Cheryl Moyer, PhD, MPH, University of Michigan.
Dr. Vik, who has more than 30 years of experience in pediatric oncology and who has worked with AMPATH colleagues in Kenya for more than a decade, said “I was struck by Dr. Nessle’s energy and enthusiasm to care for patients, as well as his inquisitive nature for clinical care and research. He has recognized that the high need for impactful research in the management of febrile episodes at the University of Michigan is not dissimilar to that in low resource countries.”
“Dr. Nessle has identified two areas within supportive care which I anticipate will have a marked impact in improving our care; identifying resistance patterns of bacteria implicated in blood stream infections while wisely exploring the perceived barriers to our parents, nurses and registrars impacting care delivery,” said Dr. Njuguna, the senior pediatric hematology/oncologist in Eldoret.
Dr. Nessle became familiar with the AMPATH partnership through Dr. Moyer, a global qualitative research expert and his mentor at the University of Michigan, who helped him network to find the right opportunity for his fellowship. “Dr. Nessle was consistently concerned about finding an environment in which his interests and expertise aligned with the on-the-ground interests of our partners,” said Dr. Moyer. “His current work at the University of Michigan around pediatric febrile neutropenia episodes aligns perfectly with the work that Dr. Terry Vik and colleagues from AMPATH are doing with Kenyan partners, and I have been pleased to see the excitement and energy created by his fellowship application.”
While he said he was still learning about all of the aspects of the AMPATH partnership, Dr. Nessle embraces AMPATH’s principle of “leading with care.”
Dr. Nessle presents at an oncology program
“You are here to improve the care for patients, and everything should be central around that,” he said. He also values the AMPATH model of partnership led by Kenyan colleagues and the comprehensive and holistic care that focuses on more than just the inpatient hospital setting. “It’s such a wise thing that AMPATH has been intentional in really thinking about the entire wellness of the people of this region and in communities.”
Dr. Nessle believes that the findings from his Fogarty Fellowship could impact care guidelines in countries beyond Kenya and he hopes to use the experience to apply for an NIH Career Development Award to build upon his current body of research in fever episodes in children with cancer.
The Fogarty Global Health Fellows experience also includes research training modules from the University of Washington. Dr. Nessle has already completed courses in project management and implementation science. “I thought they were incredibly valuable,” he said. “They taught me things that I didn’t get at any step of my training thus far. They are topics that are pertinent to research conducted in the US, but they also integrate cultural humility and a global medicine perspective into the coursework.”
Dr. Nessle also participated in a summer orientation for all of the Fogarty Global Health Fellows where he was able to meet Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, and Dr. Roger Glass, former director of the Fogarty International Center. The orientation also included workshops on qualitative and quantitative methods.
Applications for the Fogarty Fellows and Scholars program for 2024-25 will be available later this year and typically close on November 1. The Global Health Fellowship Program is a 12-month clinical research training program for post-doctorate trainees and doctoral students in the health professions in the US and post-doctorate trainees from low- and middle-income countries. The program is sponsored by the National Institute of Health’s Fogarty International Center in partnership with several NIH Institutes and Centers.