Meet Dr. Golitko
Carrie Golitko, MD, began her global health career while in her pediatric residency at Brown University. Since then, she has spent almost fifteen years overseas in Malawi, Swaziland, and Uganda, providing clinical care and instituting Prevention of Mother-to-Child Transmission (PMTCT) programs to combat the spread of HIV/AIDS.
Dr. Golitko’s first global health venture was during her second year of residency. Taking part in Brown’s overseas elective options, Dr. Golitko travelled to the Angkor Hospital for Children in Siem Reap, Cambodia. “I have always had an interest in traveling abroad and working internationally, and doing that elective confirmed that I loved it,” says Dr. Golitko. Following her time in Cambodia, Dr. Golitko had the opportunity to travel to Kenya during the final year of her residency.
With her passion for global health awakened, Dr. Golitko joined the Baylor International Pediatric AIDS Initiative (BIPAI). At BIPAI, Dr. Golitko served as a Pediatric AIDS Corps physician in Swaziland, Malawi, and Uganda, with most of her time concentrated in Malawi. “My main focus along with Baylor’s mission,” says Dr. Golitko, “was to expand care and treatment to HIV infected and exposed children. My main involvement was through coordinating mentorship teams,” she goes on to describe, “we had a multidisciplinary team. While I was in charge of organizing all the teams, if we were going on a mentorship visit, three of us in different specialties would go: myself (a pediatrician), a nurse or a clinical officer or both or a human services agent (HSA) or a community health worker, and a data clerk.”
With these groups, Dr. Golitko travelled to HIV/AIDS clinics throughout Malawi, mentoring the local healthcare and social workers, and advancing the standards of care they were able to provide. “We would try to mentor every aspect of the pediatric HIV clinic we visited at the time,” recalls Dr. Golitko, “the HSA would be out at the front of the clinic helping their staff equivalent, teaching them how to evaluate for malnutrition, for example. I would be at the back with the clinicians, and the data clerk would be working with their local equivalent to make sure all the patients were properly accounted for and documented so no one was lost to follow up.”
The main goal of the project was to “improve access to high quality HIV care and treatment even in remote areas,” Dr. Golitko summarizes. “The mentorship was meant to improve the quality of care that HIV infected and exposed children were receiving in Malawi,” she continues. Fortifying the network of rural clinics around a central hospital ensured that children and their mothers would have access to both local providers, and the opportunity to be referred for more comprehensive care available in the city. “We wanted to make high quality care accessible to all children even if they lived in remote areas,” she describes, “which we did by improving care in clinics across the nation, but we remained a resource at the central clinic and were always available for referral of more difficult cases.”
In addition to her clinical and administrative work with Baylor, Dr. Golitko additionally collaborated significantly with the Malawi Ministry of Health. The partnership between the Baylor program and the Malawian government dramatically changed the lives of thousands of children and mothers with HIV. “I worked with their HIV technical group to help scale up a Prevention of Mother to Child Transmission (PMTCT) program, Option B+,” describes Dr. Golitko.
The World Health Organization describes Option B+ as not only providing “triple antiretroviral (ARV) drugs to all HIV-infected pregnant women beginning in the antenatal clinic setting (and) continuing this therapy for all of these women for life,” but also ensuring a “further simplification of regimen and service delivery and harmonization with antiretroviral therapy (ART) programmes, protection against mother-to-child transmission in future pregnancies, a continuing prevention benefit against sexual transmission to serodiscordant partners, and avoiding stopping and starting of ARV drugs.”
These developments are crucial to saving lives and preventing maternal HIV transmission. “Malawi was one of the first countries to adopt this program to decrease the transmission rate from mothers to infants,” she adds, an implementation which has saved thousands of lives. The Joint United Nations Programme on HIV/AIDS (UNAIDS) reports a 71% decrease in the rate of mother to child HIV transmission in Malawi from 2009-2015, following Option B+ program implementation in 2011. It’s “universal lifelong HIV treatment for all pregnant and breastfeeding women,” summarizes Dr. Golitko, “by 2014 20+ countries had endorsed the option B+ for their programs.”
However, while rates of transmission are steadily decreasing, an HIV diagnosis is still heavily stigmatized, especially in rural communities. There is a “huge social stigma with HIV,” says Dr. Golitko. Sometimes in smaller communities, patient privacy is not always prioritized. Not only does this subject a child to social repercussions, it could be the first time they hear of their own HIV status, as providers aim to disclose this information at an age-appropriate time. To address this, Dr. Golitko made it a priority during the mentorship process to set an example for local healthcare workers, emphasizing the importance of confidentiality. “We helped disclose children’s status to them, and we taught the other health care workers to do that in an age-appropriate way,” she recalls.
Still, receiving an HIV diagnosis is no easy task. To help the children and teens come to terms with their new status, Dr. Golitko worked with other Baylor physicians and the Ministry of Health to roll out “Teen Clubs,” “a support program for teenagers living with HIV,” she describes. While “there’s a clinic for kids who are younger, and there is an adult clinic, there is no clinic for teens specifically,” she says, citing the need for a program targeted specifically towards older kids and teens. “Saturdays would be the Teen Club clinic with activities, and education talks,” Dr. Golitko describes, “and sometimes we would have a famous singer in Malawi come. We always had good turnout for those,” she adds, smiling.
The program was a great success, assisting these kids through a challenging point in their lives, and providing both medical and emotional support. The compassion of the local healthcare workers in their support of these kids has left a lasting impact on Dr. Golitko. “The best thing was watching the really, really amazing staff who just had a special place in their hearts for these teens,” she recalls.
“The dedication of the local healthcare workers, and the degree to which they care and also the dignity of the patients themselves, it is very humbling,” she adds with admiration. “You would have these grandmothers who were caring for the kids because the parents had died from AIDS, and they maybe had to walk for a whole day to see you,” Dr. Golitko recalls, “and they would just be so appreciative for what you do for them. I always thought, ‘No, thank you!’”
Dr. Golitko remembers especially the head nurse at the main Baylor clinic in Malawi, Princess Mutali. “Always smiling, always happy, she never seemed daunted by the number of patients in the waiting room,” Dr. Golitko recalls, adding “healthcare there it’s not easy. To be a healthcare worker, you have to endure so much, see so much suffering.” Her boss in Malawi, Peter Kazembe, also stands out in Dr. Golitko’se eyes for his perseverance. “I think it’s just the stars, these people who are just so admirable in the work they are doing and their attitude about the situation,” she concludes.
Watching the transformative power of diagnosis and proper treatment on the health and lives of the kids in and out of the clinics was also extremely impactful for Dr. Golitko. “The thing that stands out the most to me is that when I first started in 2006, many HIV infected children were not on therapy, or very few were on therapy, so the children coming into our clinics were often very, very ill and in the last stages of HIV, often beyond saving,” she recalls. “Moms would carry in their kids who were having a seizure, or they would have really bad meningitis, severe malnutrition, severe TB,” she remembers, “but as the program went on and Baylor and the Ministry of Health worked together, you stopped seeing as many kids come in in such severe stages of disease.”
Caring for these kids and watching them transform with expanding access to diagnosis and treatment was a saving grace around so much suffering and death. “I wouldn’t even recognize them but I would recognize the moms,” remembers Dr. Golitko, “and I would look at their charts and think ‘they are unrecognizable’ and we had this tradition of picking up the kid and carrying them around the clinic, saying ‘look who it is!’ They would be running around, opening draws, smiling, chubby cheeks, it was amazing.” She pauses, introspectively, “That was very personally rewarding for me.”
Dr. Golitko recalls her relationship with one little girl in Swaziland with particular fondness. “I had this one little patient whose mom had HIV and it was transmitted to the girl,” Dr. Golitko describes. “Her mom was really afraid to tell her that she had it and had gotten it from her, which is really complicated,” she adds. “We had this emotional meeting when we talked about telling her and then when I was able to tell her, to do the disclosure as we call it, they were crying and smiling by the end.” Luckily, they were able to sustain a small continuity of care, and Dr. Golitko formed a relationship with the little patient.
She smiles as she recalls a gift the little girl gave her on one of her treatment visits. When the girl started coming to her visits on her own, “she brought me a purse which was the sweetest thing ever,” Dr. Golitko remembers. Unfortunately, combating HIV was only the first hurdle. “She started losing weight, but she had a really good adherence to the antivirals, so we weren’t sure why,” tells Dr. Golitko, “it turned out she had TB.” She smiles sadly recollecting the young girl’s fortitude, “I had to tell her, and she was crying but she was so strong, only 13.” Dr. Golitko soon had to leave for Malawi, but the memory of her friend stays with her, “I was very sad to leave her, I always ask the staff ‘how is my little friend?’ The last I heard she was doing really well,” she adds.
Now back in the States after years of traveling, Dr. Golitko has come to the Global Health Initiative to serve as Medical Director. “Right now, I’m really excited to be back in America and involved in global health,” she says. However, working on global health reminds her strongly of her passion for working in low-resource settings, “it kind of makes me want to move again,” she says, laughing. The opportunity to acquaint herself with the multitude of global health projects CNHS providers are engaged in has been an especially enjoyable experience for Dr. Golitko. She is looking forward to continuing to work with and support both global health researchers and clinicians in their international partnerships.