Infectious Diseases

  1. HIV/AIDS Learning Institute: An Interdisciplinary Perspective on Important Health Issues

    May 30, 2014 by Janka Pieper

    Guest Post by Kate Klein. This post was originally published on the Northwestern Public Health Review Blog.

    Screen Shot 2014-05-30 at 11.10.04 AMFor the past year I have been working with the Interdisciplinary Health Network (IHN), a collective of public health and medicine students from all over the country, interested in creating free courses on important health issues from an interdisciplinary perspective. The IHN was founded on the core belief that an integrated approach across disciplines to combating disease is needed. IHN’s mission is to create a training program that addresses this need and to develop a network across different academic sectors.  The goal of the IHN is to empower students to achieve their goals as future global health professionals by providing a holistic educational environment that allows for innovative thinking in global health.

    As someone who has worked on HIV prevention issues, I was particularly keen to develop a course that would bring together lecturers from a range of disciplines all working on HIV/AIDS. I was able to recruit and record lectures from leaders in the fields of advocacy, laboratory work, social entrepreneurship, clinical care and operational research. I was lucky to bring in leaders in these fields who, collectively, provide a fantastic history of HIV/AIDS, what we know, how we are fighting it (in the lab, the hospital and the field) and where vaccine and prevention research is going.

    Besides the HIV/AIDS Institute, my colleagues are developing Institutes on Tuberculosis and Neglected Tropical Diseases. Each Learning Institute will be a three-week online course, with lectures that you can view at your convenience and live interactive Q&A sessions. Dates and links to the full curriculums can be found here:

    AIDS Learning Institute: June 23rd – July 12 Curriculum

    Speakers Include:
    ▪    Mitchell Warren, Executive Director, AVAC: Global Advocacy for HIV Prevention
    ▪    Alice Gandelman, MPH, Director, California STD/HIV Prevention Training Center
    ▪    Dr. Shannon Galvin, Director of Clinical Programs and Training, Center for Global Health, Northwestern University
    ▪    Dr. Laila Woc-Colburn, Director of Medical Education, National School of Tropical Medicine and Assistant Professor, Infectious Diseases, Baylor College of Medicine
    ▪    Dr. Joseph Tucker, Assistant Professor, University of North Carolina School of Medicine, Director UNC-China Programs
    ▪    Dr. Dorothy Lewis, Professor of Infectious Diseases, Internal Medicine, University of Texas-Houston

    TB Learning Institute: July 7-July 25 Curriculum

    Speakers Include:
    ▪    Dr. Amy Bloom, Senior Technical Advisor, USAID
    ▪    Colleen Daniels, TB/HIV Project Director, TAG Zeroes Campaign

    NTDs Learning Institute: (pending -TBD in July) Curriculum

    Speakers Include:
    ▪    Dr. Peter Hotez, Founding Dean, National School of Tropical Medicine

    These courses are meant for just about anyone with an interest in the topic. If you are would like to apply, the application can be found on the IHN website, http://www.ihealthnetwork.org.

  2. Pneumonia, leading cause of death in children

    April 4, 2014 by Kathleen Ferraro

    Seeing as many of my courses and global health experiences have focused on the same few global health initiatives, I thought I would take a look at other conditions that I have encountered less frequently: for instance, pneumonia.

    Distribution of deaths from pneumonia and other causes in children aged less than 5 years, by WHO region. Image Courtesy: WHO

    Distribution of deaths from pneumonia and other causes in children aged less than 5 years, by WHO region. Image Courtesy: WHO

    Pneumonia–a respiratory infection in the lungs brought on by viruses, bacteria, or fungi that causes painful breathing and limited oxygen intake–is the leading cause of death in children throughout the world. The WHO measures the specifics of this data, detailing that 1.1 million children age five and under and killed by  pneumonia every year; most of which are in sub-Saharan Africa and South Asia.

    In sub-Saharan Africa, people living in extreme poverty are particularly susceptible to contracting pneumonia due to malnourishment, poor sanitation, and contaminated food and water sources. Furthermore, sub-Saharan Africa hosts some of the highest rates of HIV in the world, and HIV puts an individual at a higher risk of developing pneumonia. The deadly combination of HIV and pneumonia necessitates numerous and expensive medications, assuming these medications can be obtained in the first place. And even if patients obtain the right treatments, they are at increased risk of developing resistance to the drugs.

    Like sub-Saharan Africa, people in South Asia are at higher risk of pneumonia due to extreme poverty. Indoor air pollution, smoking, and chronic obstructive pulmonary disease are other risk factors prevalent in the region. Again, high rates of HIV are problematic due to increased risk of contracting pneumonia, excessive medication, and drug resistance. While there are many existing interventions designed to combat pneumonia in South Asia, few of these interventions are present in places where they are needed the most: consequently, pneumonia remains a significant problem.

    As with many common infections, pneumonia is easily prevented and treated given easy access to primary care and antibiotics. Immunization, good personal nutrition, personal hygiene, and a healthy, sanitary environment are all prevention strategies. Treatment involves a simple round of antibiotics. While these prevention and treatment are effective for those with access to medical care and who live in a stable, healthy environment, pneumonia often proves fatal for those already experiencing malnourishment or unhygienic living conditions.

    What can be done? Because the bulk of pneumonia-related deaths occur in impoverished countries, attending to environmental risk factors (pollution, water sources, food sources, overcrowding) is one preventative measure. As far as treatment interventions go, there must be increased access to care via community health workers or clinics who can provide vaccinations, antibiotics, and/or clean oxygen. The WHO has taken steps to address both prevention and treatment strategies in regions where pneumonia is a leading cause of death with the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea, which aims to end preventable deaths by pneumonia and diarrhoea by 2025. This initiative includes the dispersal of vaccinations, soap, clean indoor stoves, water treatments, promoting breastfeeding, and, of course, working to expand the reach of clinics and health workers.

    Northwestern’s 2014 Global Health Case Competition focused on this often-overlooked problem. The Case Competition featured eight teams, all of whom were presented a case about childhood pneumonia and then asked to develop a solution. Elizabeth Larsen, a sophomore participant, emphasizes the significance of the issue, stating, “It’s important to give attention to the often overlooked problem of childhood pneumonia because it continues to kill millions of children around the world.” Because of this far-reaching impact, it is important for events like the Global Health Case Competition and individuals everywhere to continue to focus on pneumonia.

  3. Working on a project that matters where it matters most

    March 21, 2014 by Janka Pieper

    This post was originally published on International Program Development’s NU in South Africa blog. Blogger Sarah Uttal is wrapping up her time in South Africa on IPD’s Global Healthcare Technologies program at the University of Cape Town and reflects on how her group’s work had an immediate positive impact on a primary care facility in Cape Town.

    As our time in Cape Town draws to a close, we are all working hard to finish up our design projects we have worked on all quarter. This quarter has given each of us the opportunity to design a medical device to be used in South Africa, dealing specifically with South African health problems. Our classes here also taught us how to correctly think about these devices in a broader setting of health technology management and their potential cultural impact.

    I got to work on a redesign of the current respirators used to protect against tuberculosis (TB) infection. We first came across these respirators during our time in KwaZulu-Natal when we had to wear them before entering a TB ward. Since TB is one of the top five causes of death in South Africa these respirators are used all over the country, but that does not mean they are the ideal way to protect oneself from the disease. We actually found them almost unbearable and decided there had to be a more comfortable solution to this problem. It was great to experience a problem first hand, hear the impact a better solution would have, and then begin to work on it in the setting where it would be implemented. We were able to speak to so many professionals around Cape Town and even around the country who gave us insights into why these respirators are not functional and how we could work to make them better. This is exactly what I was excited about doing before coming to Cape Town, working on a project that matters where it matters most.

    Our entire group also worked on a waiting time study at the primary care facilities around Cape Town. People here wait for hours before being seen by a doctor and the government called us in to figure out why. We spent long days in clinics tagging patients and tracking clinic flow to determine where the system was failing. This meant hours of patient contact every day as people approached us telling us their problems with their healthcare system and letting us know how we could help fix it. This was another design project where we could really make a difference immediately. It is hard as an outsider to come into a South African community health clinic without much previous knowledge and try to change the system, which is why these patient anecdotes were so valuable. After multiple full days with 5:45am starts we began to get the hang of the clinic flow and figured out how to tag all the patients coming to clinic. We also began to observe some problematic trends and best practices we are now able to pass on to administration. We learned so much about the primary health care system’s successes and failures by being a part of this unique experience. It was definitely hard work but hopefully we made an impact and will have made those wait times a bit shorter for a frustrated patient population. It is great to know we are leaving having helped a country that has given so much to us these last few months.

  4. Applying What We Learn Abroad Back Home

    November 6, 2013 by Michael Miller

    If you’ve spent time in the field of global health, you’ve probably been asked the question, “Why focus your time internationally, when there is so much need here at home?” While it is an interesting and certainly important question, I think it rests on an assumption that is fundamentally flawed. Quite simply, the question creates a dichotomy between domestic health work and international health work, presupposing that the challenges faced abroad are somehow dissimilar to the ones we face here at home. It assumes that one must choose between the international and the domestic, instead of understanding that the study of health abroad is in fact the study of health in the US. Unfortunately, this limitation is not just characteristic of the people asking the question, but also of the people answering it, as global health academics and practitioners have frequently lacked the creativity or humility to translate models of success between international and domestic contexts.

    The most immediate objection to my claim is that there is a significant difference in the health burden faced by different countries around the world. More commonly known as the epidemiological transition, this argument basically holds that during the twentieth century the major health concerns of developed countries switched from infectious diseases to chronic diseases, while in the developing world they remained as infectious diseases. There is no arguing this, and in absolute terms the health crisis and burden of diseases present in the developing world are very different than they are in the US or Canada or much of Europe. For example while HIV/AIDS continues to be a horrific epidemic in many parts of Africa, the US and Europe has greatly excelled in the disease’s prevention and treatment (even greater disparities exist in the prevalence of Tuberculosis). But while the types of disease may be different, that by no means implies that the solutions are not translatable. What do I mean by this?

    The most readily available example is community health workers. Over the years, community health worker models have become a staple of human resource expansions in Ministries of Health all over the developing world. They have been a vital part of increasingly stable drug retention rates, immunizations and other preventative care, as well as an invaluable link between clinics and communities. Yet despite this success abroad, very little attempt has been made to implement a similar model at home, despite structurally equivalent problems with drug retention, preventative care, and clinic to community connection.

    What can we learn from this? The first is that maybe it’s time to implement a community health worker model in the US, both because it has the potential to improve health outcomes and also because under the Affordable Care Act there is a financial incentive for clinics and hospitals to engage in such preventative practices (Paul Farmer has actually recently harped on this idea). And the second is that we begin to understand that while there are degrees of scale separating the health challenges faced by certain parts of the developing world and the US that does not mean that the solutions generated abroad are compromised here at home.

    In the long history of health work, the vocabulary eventually shifted from international health to global health partly because people recognized that domestic issues were always a part of international challenges. It is essential that we honor that legacy by applying many of the lessons learned far away to our problems here at home. By no means, does that mean we should adopt one-size-fits-all models to global health challenges, because cultural, geographic, political and economic context certainly matters, but it does mean that we start using the ingenuity directed abroad to solve the crisis here at home and vice versa. Development and global health are two way streets despite how much we try to act like our problems are so different than those of developing countries.

    The short answer to the question of whether or not to work domestically or internationally should be that we have a responsibility to do both. Luckily that does not mean that one must split their time working on issues at home and those abroad, but rather that the field of global health must harness the genius driving international progress with the genius driving domestic progress and combine them to achieve truly global change. It’s not an easy task but one that we must seriously pursue if we are to achieve any semblance of health equity here or abroad.

     

  5. On the Brink of Eradication: The Polio Epidemic

    October 30, 2013 by Lajja Patel

    Polio is a highly infectious and crippling disease that primarily infects children. The poliovirus attacks the brain and spinal cord, causing paralysis within hours. Perhaps the most devastating nature of the disease is that it is completely preventable, yet twenty-five years after the polio vaccine was assembled, only seventy-five percent of the world has access to it.

    "RI President Ron Burton sounded the call to the audience and global viewers on line to help make history by eradicating polio." Courtesy of rotary.org. Photo Credit: © Rotary International/Tim Walters

    “RI President Ron Burton sounded the call to the audience and global viewers on line to help make history by eradicating polio.” Courtesy of rotary.org. Photo Credit: © Rotary International/Tim Walters

    In 1988, when a startling 350,000 cases of polio were reported worldwide, the World Health Assembly, along with UNICEF, U.S Centers for Disease Control and Prevention, and Rotary, resolved to eradicate the poliovirus and launched the Global Polio Eradication Initiative. Although the global eradication plan has reduced the number of cases of polio from hundreds of thousands to just hundreds, the final reservoirs of resistance in Nigeria, Afghanistan, and Pakistan, where the virus is still endemic, have provided the greatest hardships for public health authorities.

    On the evening of October 24, Rotary, in collaboration with Northwestern University’s Center for Global Health, held a special program entitled “World Polio Day: Making History” to highlight the advancements in the global effort to end polio, to stress remaining challenges, and to emphasize the importance of securing a polio-free world.

    Rotary International, also known as Rotary Club, is a global network of volunteer leaders combating the world’s most pressing humanitarian challenges. Rotary’s 1.2 million members are a group of business and professional leaders from over two hundred countries whose mission is to create positive, lasting change in local and global communities. The event was streamed live to a global audience and about two-hundred invited guests attended.

    Dr. Robert Murphy, director of Center for Global Health – Institute for Public Health and Medicine at Northwestern University Feinberg School of Medicine, spoke about the implications of polio eradication on the global health platform. Dr. Murphy noted that polio eradication will “rank amongst the greatest global health accomplishments in history,” however; the last 1% of cases will be the hardest to prevent. Dr. Murphy also commented that polio eradication will demonstrate that even regions teeming with slums and unceasing conflict can be navigated and reached with vaccines and essential healthcare services.

    Dr. Bruce Aylward, assistant Director-General for Polio, Emergencies and Country Collaboration, noted that unlike other devastating, painful diseases, polio is different because it is completely curable with two drops of the polio vaccine. The fate of many lives depends on the accessibility of a mere two drops.

    India, which was declared polio-free in February 2012, was considered one of the most difficult countries to end polio due to its poor sanitation, high population density, and migrant communities. Dr. Alyward noted that some global health specialists increasingly and boldly claimed that it was impossible to eradicate polio in India for aforementioned reasons. However, India’s success serves as an example of how robust tactics could be successful in even the most aggressive reservoirs of polio. India used a combination of innovative, micro-scaled techniques, including dispatching small teams of polio workers, marking children’s fingers with enduring ink to assist in locating missed children in larger public venues, and chalking houses to indicate unvaccinated children. In addition, when parents declined vaccines for their children, a second team of polio workers and highly respected local villagers were dispatched to convince the parents that the vaccine would protect their children. Since the poliovirus lurked and moved with the mobile Indian population, India turned to public transportation sites and assigned volunteers to halt busses and trains to distribute vaccines to unprotected children. Over the course of several days, many volunteers vaccinated 170 million children in India.

    "Dennis Ogbe, polio survivor, Paralympian, and ambassador for the United Nations Foundation’s Shot@Life campaign, urged everyone to help remove the threat of polio to children’s lives."Photo Credit: © Rotary International/Tim Walters

    “Dennis Ogbe, polio survivor, Paralympian, and ambassador for the United Nations Foundation’s Shot@Life campaign, urged everyone to help remove the threat of polio to children’s lives.”
    Photo Credit: © Rotary International/Tim Walters

    Recently, ending polio was declared an emergency for global health. The final reservoirs of polio are Nigeria, Afghanistan, and Pakistan. In these countries, polio persists at the margins of society where critical health services are lacking or even nonexistent. As a result, the greatest challenge for workers has been to vaccinate enough children to drive immunity levels above a threshold percentage, whereby herd immunity is achieved. Healthcare officials have trouble accessing the geographically isolated and terrorist-controlled areas that are native to Pakistan and Afghanistan. Making frequent trips to these remote, mountainous communities is labor-intensive, dangerous, and requires proper maintenance of vaccines during long trips. In order to face the challenges, police officers have been stationed to allow health care officials to safely access children in need of vaccines. In addition, the leaders of the Muslim world have come together to form the Islamic Advisory Group (IAG). In light of recent rumors that the vaccines were a part of an American plot to sterilize children, the IAG exists to educate Muslim parents about the importance of having their children vaccinated.

    Allegiances have been built; strategies have been established. Type 2 polio has been eradicated and as of November 2013, type 3 may be vanquished forever. If this is the case, targeted vaccines can be developed to fight the final remaining Type 1 strain. As of today, we have the tools, we have the tactics, and we even have the political backup to complete eradication in the final three endemic countries. Type 1 polio continues to challenge our stamina to eradicate polio, however, hundreds of lives are dependent on two drops of this vaccine, and together, we can distribute them successfully. With record low cases of polio and the world health community behind this newly released, methodical, data-driven, and adequately funded campaign, polio, the disease that has crippled millions, stands on the brink of being eradicated forever. If successful, a new generation of children will be saved from the clutches of the fatal and debilitating poliovirus.

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