Global Health Blog

  1. Feinberg Global Health Day gathers panel to discuss Ebola outbreak

    September 11, 2014 by Arianna Yanes

    Ebola has been on the global radar the past few months and the current outbreak in West Africa continues to spread rapidly. As a part of the Feinberg School of Medicine’s Global Health Day, hosted by the Center for Global Health, a panel of experts from the university came together for a presentation and panel on the current state of the ebola outbreak.

    Chad Achenbach explains the basics of the ebola epidemic to attendees

    Chad Achenbach explains the basics of the ebola epidemic to attendees

    Chad Achenbach, Assistant Professor in the Division of Infectious Diseases, started the presentation with foundational knowledge about the virus, describing how it started and how it continues to be transmitted. In 2004, he said, this particular strain of the ebola virus, EBOV, was circulating around animals. It remains unclear how it was introduced into humans in this outbreak. This is the largest outbreak of ebola in history, with 42% of the nearly 4,000 cases from the past month, he said.

    The virus strain of the ebola outbreak doesn’t appear to be more virulent or have higher case fatality rates than other outbreaks- so, why does this outbreak have more cases than all other ebola outbreaks combined? As Achenbach described, unlike past outbreaks in more rural areas, this virus has made its way into dense urban areas, as a result of increased mobility of populations to move within countries and across borders.

    The Center for Global Health at Feinberg is currently collaborating with a laboratory in Mali to test samples for the presence of the ebola virus. Of twenty samples received thus far in Mali, all have been negative. Achenbach anticipates this lab will be “active and very involved” in the coming months.

    “It’s been done before. We can do it- it’s just going to be a massive effort,” Achenbach said in regards to controlling transmission.

    After Achenbach’s presentation, the discussion was opened up to the panel, moderated by Robert Murphy, director of the Center for Global Health. Panel member Juliet Sorensen, Clinical Associate Professor at Northwestern Law School, described the role of the World Health Organization as that of a “global coordinator” to control the virus in the short term. However, the WHO is only as strong as its member countries, she described.

    “Now is the time for the international community to step up,” Sorensen said.

    The panel had Baldwin Auditorium at capacity with members of the Northwestern communit

    The panel had Baldwin Auditorium at capacity with members of the Northwestern community

    Jennifer Chan, Assistant Professor of Emergency Medicine at Feinberg, identified communication as one of the greatest challenges in this outbreak. Difficulties arise not only in getting messages to local communities about what to do, but also in getting the communities to trust the messages they receive.

    Mike Schmidt, also an Assistant Professor of Emergency Medicine at Feinberg, addressed the protocol of Northwestern Memorial Hospital’s Emergency Department in regards to ebola. Each patient is screened for travel history and potential exposure to the virus as part of the initial evaluation. Though no patients have presented at the hospital with the virus, Murphy described Chicago as a city with many travelers to and from West Africa.

    “If the person had a travel history that was concerning, those patients would be placed in particular areas of the emergency department where we can isolate them,” Schmidt described.

    Following the panel, a poster session showcased student research and projects in global health. In the evening, the Global Health Social Hour gave students and residents the opportunity to share abroad experiences and discuss project successes and challenges. On the Center for Global Health’s Facebook page, images capturing these travels are displayed as a part of a photo contest. Take a look at what the medical students have been doing and “like” your favorites to vote.

    Feinberg students presented global health projects and research from all across the world

    Feinberg students presented global health projects and research from across the globe

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  2. Mobile health: Uses and growth at home and abroad

    September 10, 2014 by Arianna Yanes

    Source: gsma.com

    Mobile health (mHealth) is the use of mobile phones and technologies, such as tablets, to improve health access, outcomes, delivery, services, and research. The field requires individuals from multiple disciplines, such as medicine, public health, business, computer science, to come together and produce products that serve in both developing and developed nations.

    Cell phones are increasingly prevalent in low and middle-income countries (LMIC), while access to health care systems and providers can be challenging. In this way, mHealth can be a valuable tool for improving health access and outcomes and filling in some of the gaps which providers cannot. mHealth can also be useful for delivering care and education here in the United States, though the technologies serve different functions than in LMIC.

    With the growth of mobile phone usage and the needs of patients around the world, mHealth will continue to grow and serve diverse purposes. A report by Grand View Research estimated the value of the global mHealth market to be $1.95 billion in 2012, with an estimated annual growth rate of 47.6% from 2014 to 2020. Monitoring services, such as chronic disease management and vital signs tracking, accounted for 63% of the market.

    Just earlier this year, researchers at Northwestern and the University of Illinois published a report in Science detailing the design of a new soft, adhesive patch for physiological monitoring. A 2013 graduate of the Feinberg School of Medicine, Diana Cohen, developed an app called diet & acne to deliver information about connections between foods and acne, based on peer-reviewed literature. From April 1, 2013 to Aug 31, 2013, the app was downloaded in 98 countries.

    The NIH currently has a research funding opportunity entitled “Mobile Health: Technology and Outcomes in Low and Middle Income Countries,” under the R21 Exploratory/Developmental Research grant category. This demonstrates the perceived potential and need for the new technologies for use in these nations.

    Additionally, an annual mHealth Summit is held to bring the minds working in the field together. This year, innovation and evidence will be emphasized as delegates share successes and challenges in their endeavors.

    One mHealth platform, emocha, demonstrates the variety of potential applications of mobile health. Here are five brief examples of projects with diverse methods and objectives.

    1. Weight management (Maryland, USA)- A platform was created to send users motivation and tips via text message. As a follow up, the data will be analyzed and managed.

    2. TB screening (Panama and Mexico)- emocha used WHO guidelines to create an interactive TB symptom screening application. This project also included educational tools to keep providers up to date on TB care.

    3. Chagas control (Bolivia and Mexico)- If the Chagas insect is found during household assessments, emocha coordinates appointments to decontaminate the homes.

    4. Domestic violence intervention (Maryland, Virginia, Wisconsin, USA)- Using a tablet, patients are shown informational videos and screened. Questionnaires in the application assess the risk of domestic violence and also provide care referrals.

    5. Dengue control (Colombia)- Once water containers are tested for bacteria, photos are uploaded to the emocha platform with geo-locations and are managed there.

    These examples are just a few of the numerous examples of mHealth. The projected growth of the industry makes it worthwhile to stay updated with the latest in mHealth.

    To find out more about NIH’s funding opportunity for mHealth, visit http://grants.nih.gov/grants/guide/pa-files/PAR-14-028.html. To learn about the mHealth Summit, visit http://www.mhealthsummit.org/. To discover more about emocha, visit http://www.emocha.com/.

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  3. Equipping Dominican HIV providers with the tools for best patient care

    August 13, 2014 by Guest Bloggers

    Guest post by Dr. Ramona Bhatia, Clinical Research Associate, Center for Global Health, and Instructor of Medicine, Feinberg School of Medicine

    The Project CURE shipping container arriving at the Clínica de Familia La Romana

    Arrival of the Project CURE shipping container at Clínica de Familia La Romana

    Physicians such as myself practicing in high-income countries are privileged to utilize the latest medical technologies for patient care. In the majority of healthcare settings globally, however, even the most basic medical supplies, such as gloves, gowns, and gurneys, are limited, and more sophisticated technologies are exceedingly rare.

    In my role as a global health clinical researcher in the Center for Global Health at the Feinberg School of Medicine, I had the pleasure of traveling to the Clínica de Familia La Romana in October 2013. Located in the La Romana province in the southeastern part of the Dominican Republic, Clínica de Familia is the second largest HIV clinic in the country. It provides subsidized care to approximately 1,600 patients, including a large proportion of vulnerable Haitian migrants living in neighboring bateyes (sugarcane labor camps). My initial task was to develop and implement a Spanish-language training course on the latest HIV care updates for Clínica providers, but from my conversations with Clínica leadership and site visits I quickly realized that more than a care update was needed. A lack of medical equipment, such as an EKG for heart tracings, was preventing Clínica staff from providing the best care possible to their patients.

    The container was fully stocked with needed medical supplies

    The container: Fully stocked with needed medical supplies

    To address the supply shortage, the Center for Global Health, with support from Northwestern Memorial Hospital, formed a partnership with the not-for-profit group Project C.U.R.E. Project C.U.R.E. is the largest supplier of donated medical supplies to developing countries around the world. One of my responsibilities was to assist with the on-site Project C.U.R.E. needs assessments in the Clínica de Familia and neighboring hospitals, including one in Guyamate, a bateye and Northwestern University Access to Health site. Conducting detailed assessments was important to ensure that donated supplies would be needed and could feasibly be used. We interviewed providers for first-hand accounts of the supplies that were most needed and discussed logistics with Clínica leadership, including availability of regular maintenance for large equipment, proper storage facilities, and personnel to safely and effectively utilize certain technologies.

    Three months later, in January 2014, a large shipment of supplies was loaded onto a shipping container in Denver and set sail from Houston for the Dominican Republic. After travel and customs processing, the shipping container carrying tens of thousands of dollars worth of medical supplies arrived at the Clínica de Familia in July 2014. The community came together for the large undertaking of unloading the supplies at Clínica de Familia.

    Today, just a few weeks after the arrival of the shipment, providers are already utilizing some of equipment: The EKG machine is being used for heart rhythm examinations and the colposcopy equipment is set up to begin women’s health exams, all due to the targeted matching of supplies with the Clínica’s needs.

    We plan to return to La Romana next year with the first group of Feinberg medical students to engage in HIV and primary care medical rotations at the Clínica de Familia. I’m hoping to see these supplies contributing to a sustained improvement in health care for HIV patients in the La Romana community.

    Unloading the container: A community effort

    Unloading the container: A community effort

    CommunityEffort

    Clínica de Familia La Romana staff checking supplies

    Setting up the colposcopy machinery for women's health examinations

    Setting up the colposcopy machinery for women’s health examinations

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  4. A Toxic Cycle

    August 7, 2014 by Haley Lillehei

    As a student of global health, I pride myself on keeping up to date on the various challenges to public health around the world, especially the most potent issues. I know about AIDS and malaria, I know about the problems with health insurance in China, and I know the struggles resource poor nations face in giving care, to name a few. So imagine my surprise when I came across a topic I knew nothing about.

    This past May, over 100 people died in a toxic alcohol outbreak in eastern and central Kenya. Others woke up blind after sleeping off the alcohol’s effects or lost their sight over the course of a few days. In Kenya, and other countries in the area, bootleg liquor is extremely common, as factory made alcohol is too expensive for most people to buy. Many of these locally made brews are laced, both intentionally and unintentionally, with industrial alcohol to increase their potency.

    How does this toxic alcohol kill? What makes it so much worse than the ethanol that so many people across the world drink? I spoke with Dr. Patrick Lank and Dr. Vinoo Dissanayake in an attempt to wrap my head around this deadly poison.

    Ball and Stick Model of Methanol. Source: Wikipedia

    Ball and Stick Model of Methanol. Source: Wikipedia

    Dr. Lank, a toxicologist at Northwestern’s Feinberg School of Medicine, explained to me what happens to the body after one consumes methanol. Methanol, or methyl alcohol (CH3OH), is widely used as an industrial solvent and paint remover. It is also commonly used as a component of photocopying fluid, shellacs, and windshield-washing fluid. When ingested, methanol is primarily metabolized in the liver into formaldehyde via alcohol dehydrogenase. Formaldehyde is then metabolized into formic acid, which ultimately breaks down into folic acid, folinic acid, carbon dioxide, and water. Formic acid is responsible for the toxic effect of methanol in the human body.

    In the United States and other developed countries, there are very specific treatments in response to toxic alcohol poisoning. These include hemodialysis, oxygen and breathing support, gastric lavage, and fomepizole, an antidote intended to reverse the effect of the poison. Another remedy is consumption of ethanol, or the alcohol we typically drink, like beer, wine, or whiskey, to name a few. When ethanol is ingested, it competes against the methanol to be metabolized, and the body digests ethanol instead. This prevents the formation of the toxic metabolites that result from the digestion of methanol. Often times when we see alcohol poisoning involving methanol in developed countries it involves individual cases: someone is suicidal, addicted, or another isolated cause. A hospital can focus on using all the available interventions to save a life. This is not the case in developing countries.

    Dr. Dissanayake, a medical toxicologist at Loma Linda University Medical Center in Loma Linda, California, explains that alcohol poisoning is a good example of the struggle behind resource limitations in developing countries. There is often limited access to hospitals and doctors, and if one does make it to one, it is often at the very last possible minute, once they have exhausted all home remedies and they are still alive. Dr. Dissanayake has spent time in Uganda doing global health work. During her time there, she has experienced first hand the burden a methanol-poisoning outbreak would place on communities.

    Uganda Waragi. Source: Wikipedia

    In Uganda, illicit alcohol is called waragi, and was introduced by the British to give Ugandan soldiers courage to impose the Queen’s policy on their countrymen. It has since become the drink of choice for most Ugandans. According to a 2004 World Health Organization ranking of countries based on per capita alcohol consumption, Uganda has the highest alcohol consumption in the world, with adults consuming 19.5 liters of alcohol per year. “If someone in the village is sick from drinking, they are one of many drunk patients, and it would be nearly impossible to determine who may actually be poisoned rather than just drunk,” says Dr. Dissanayake. An additional strain on the already resource-poor medical facilities is created through excessive alcohol consumption.

    With a high number of intoxicated patients and limited professionals, the most common response is to let an intoxicated patient sleep it off, and thus the cases of those who have been poisoned by methanol are often discovered too late. Alternatively, if the poisoning is discovered in time, and if a person does make it to a hospital, the best option is to fight the poison with ethanol. However, methanol has a half-life of 40 to 50 hours, so according to Dr. Lank, a patient must be kept drunk for about 10 days to survive the toxic methanol. Most patients do not have the resources to pay for this treatment.

    The other option is to have the patient transferred to a referral center where hemodialysis can take place. Dr. Dissanayake explains that hemodialysis is a medical procedure that will filter the patient’s blood and remove toxins, preventing toxic metabolites from forming. This procedure would happen without hesitation in the US, however only certain hospitals have this capability in Uganda. “The closest referral center to Nyakibale Hospital [a hospital in Uganda where Dissanayake has volunteered] is 3 hours away by motorbike,” says Dr. Dissanayake. There are very few ambulances available in rural Uganda.

    So why is this happening in places like Uganda and Kenya? Drinking is a highly political issue, as alcohol is one of the largest sources of revenue. Local politicians are reluctant to partner with law enforcement based on a fear that stricter laws will be bad for business. At the same time, the government doesn’t see toxic alcohol poisoning as a large public health issue. Drinking is viewed as part of the culture in Uganda. However, according to Ioannis Gatsiounis for Time Magazine, some observers estimate the costs of alcohol in the country, both economic and social, are worse than those of HIV and malaria. “It’s a double-edged sword,” Dr. Dissanayake says, “people are so depressed that they can’t make enough money to make ends meet so they drink. But then they can’t go to work the next morning and the cycle continues.”

    Ultimately, the ripple effect of a failing economy is felt in the limited resources of the medical system as well. One answer to the problem lies in global partners to try and educate local providers on the best way to manage these poisonings and stop the cycle. However, enforcement of the policies by the government may play a more meaningful role.

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  5. A New Way Forward

    August 6, 2014 by Elizabeth Larsen

    Chicken - Piura - Peru (1 of 1)

    Though they lie thousands of miles apart, the countries of Guatemala and Peru continue to fight against the same seemingly unconquerable struggle: childhood malnutrition.

    In both countries, nationwide data masks the severity of the problem. In Guatemala, childhood stunting affects around 50% of children under five, yet the prevalence soars to 70-80% in many indigenous communities. The disparities in Peru are equally as stark. In fact, the country is often overlooked by agencies providing nutritional support as the overall prevalence of childhood malnutrition is only about 15%, even though indigenous communities continue to see rates of 40, 50, even 60%.

    As you can see, the problem of childhood stunting in Latin America is extremely prevalent, but it is not widespread. It is concentrated in impoverished indigenous populations that have faced years of racism, marginalization, and abuse. How can we begin to solve the nutrition crisis that was created by decades of political, economic, and social oppression?

    The answer is not easy or immediately obvious. As you can quickly see from examining the data on stunting over the last few decades, the world has struggled to make significant progress despite the best efforts of governments and bilateral aid organizations. For example, malnutrition rates in rural Peru fell 0.3% in the ten years from 1996 to 2005. Even though change seems to be accelerating in the majority of countries, it is not fast enough, nor consistent in its reach. In fact, as of 2010, fifteen countries now have a childhood malnutrition prevalence that is higher than it was in the 1990s.

    Luckily, hidden in the shadows cast by governments and foreign aid, small grassroots organizations have been hard at work achieving remarkable success at improving the nutritional health of their communities’ children. For the past month, I have had the remarkable privilege and honor to investigate some of these programs first hand. Though their strategies are incredibly diverse, their passion for nutrition is identical.

    For example, Wuqu’ Kawoq runs a patient centered nutrition program completely in the indigenous language of Kaqchikel, the language of many Mayan Guatemalans. In one community named Paya, the mothers of the children enrolled run the program themselves, taking all of the height and weight measurements to be recorded in the system. In another one of their communities, the director of the nutrition program was unable to find additional children to be admitted, as they were all growing adequately. This is what success looks like.

    Close by in the highlands around Panajachel, Mayan Families runs an innovative and unique nutrition preschool program. Mothers are able to drop off their children for a daily program of Spanish lessons, supervised playtime, and a healthy breakfast and lunch. Looking at the data, many kids aged three to five years have made substantial growth gains, a big step toward overcoming the infantile malnutrition that many suffered. This is what success looks like.

    An entire hemisphere away in the high altitude mountains of Peru, a young organization called Sacred Valley Health is training women to become health promoters in their communities, providing basic primary care and education about nutrition, sanitation, and disease prevention. They have more than doubled the number of health promoters in the last two years, allowing for important lessons about nutrition to be disseminated to more and more communities. This is what success looks like.

    Toward the middle of the country, Future Generations is proving that a nationally sponsored health program called Community Health Administration Associations (CLAS) can be reformed to provide citizens with first class primary care. By developing accessible and accurate materials to train nurses to train community health facilitators, Future Generations has increased the rate of exclusive breastfeeding in Huancayo from 71.8% to 95.3% and has decreased the rate of malnutrition in children under two by almost 7% in just one year. This is what success looks like.

    And last, but certainly not least, Feed the World is re-imagining agriculture in Northern Peru, one of the world’s most arid areas. By distributing loans of seeds and agricultural tools to farmers, along with providing extensive education on dry farming techniques, Feed the World equips farmers with the tools necessary to cultivate nutritious crops to feed their families even working within difficult circumstances. After the first year of the program, the regional and local government, along with the local university have taken over 74% of the project’s costs, a substantial investment in a previously ignored problem. This is what success looks like.

    As I hope is clear by the examples above, the power and impact of small community based organizations to affect change cannot be underestimated. If we wish to make a profound difference in the prevalence of malnutrition around the world, we must not only wholeheartedly embrace the lessons on how to achieve large scale impact with a small scale, community approach, but we must continue to invest in these grassroots organizations and their fearless leaders who are working day in and day out to create a way forward.

    If you are interested in learning more or inspired to support one of the causes above, you can access their websites at the embedded links throughout this post. 

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