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Global Health students work to perfect technologies that aid in kangaroo mother care

Eric Liu and Graham Marcy review community healthcare center (CHC) layouts with Professor Kelso during class.

Several students have recently returned from South Africa, where they worked testing various technologies developed for maternal and neonatal healthcare.

As part of the Global Health program, students from various levels – undergrads as well as graduates – are working on developing appropriate technologies for new mothers and babies.  Among the most important of these technologies are instruments designed to aid in kangaroo mother care, a process whereby premature infants are placed against the mother’s chest rather than in incubators.

“We’ve become pretty convinced that it’s the right way to do things,” said Matthew Glucksberg, professor of biomedical engineering at Northwestern’s McCormick School of Engineering. “Incubators are really pretty bad places for babies to be.”

The alternative?

Placing babies on the mother’s chest between the breasts ensures proper temperature regulation for the infant, since this area of the mother’s body automatically adjusts to the child’s needs.  Though an ancient and very natural practice, kangaroo mother care does have its drawbacks.

“The problem, among others, is that this isn’t going to spread until there’s instrumentation,” Glucksberg said.  In other words, there are problems the mother cannot administer to without the aid of technology.

Premature infants can stop breathing spontaneously, for instance.  They need phototherapy for jaundice (the blue light helps bleach out bilirubin, a natural compound that results from the breakdown of blood and can make preemies look yellow).  They need CPAP, or continuous positive airway pressure, to ensure proper breathing.

This is where project development comes in.

“We’ve been trying to build devices that essentially are a neonatal ICU all on the mother’s chest,” Glucksberg said.

The idea, he explained, is to bring the incubator to the mother and child, in bits and pieces.  Since the mother’s chest is such a better place for the infant to be, administering to various needs – proper breathing, blue light, etc. – should happen without separation.

In response to this need, students have worked on testing various products – a blanket that provides blue light, a breathing apparatus that attaches to the infant’s mouth without producing sores.

As David Kelso explained in a recent video live from Capetown, these projects were designed by previous students and some are in the process of being seriously appraised for their viability and market-readiness.

The program, which has been ongoing for the last six years, encompasses other technologies as well.

“What we do really falls into three general areas,” Kelso said. These areas comprise issues of preventing transmission of HIV from mother to child, saving lives at birth and upskilling healthcare workers.

Kangaroo mother care falls into the second category, but the other two are very important in a country rife with poverty and HIV.

The professors and students who work on these projects hope eventually to pass the results off to people within the healthcare system there.  By making sure the devices fit within already-used methods (like breastfeeding or kangaroo mother care), Northwestern’s contributions have a much greater chance of lasting impact.

“We end up building global capacity instead of just coming in and solving people’s problems for them,” said Michael Diamond, adjunct professor in McCormick’s biomedical engineering department.

Diamond, who has been instrumental to the development of student-driven global health efforts at Northwestern, said he believes strongly in the program’s emphasis on self-reliance.

“There is actually a philosophy behind all these initiatives,” he said.

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One drop at a time: Northwestern students tackle water sanitation in a far-flung Indian desert

A few weeks ago, three Masters students left for the remote Thar Desert in Rajasthan, India.

On the docket? Investigating the water that sources 140 villages in the salty, arid desert. As part of the Global and Ecological Health Program, a Master’s-level add-on to Northwestern’s biomedical engineering degree, the program is intended to help students learn to assess and learn from problems firsthand.

This is a skill engineers must learn from the ground up, said Matthew Glucksberg, a professor of biomedical engineering at Northwestern’s McCormick and one of the program’s coordinators.

“You can’t just come in from the outside and expect people to implement your great idea,” Glucksberg said, adding that this is a mistake many make when they are out in the field. “Good solutions are integrated into the way people are already doing things.”

In other words, understanding comes before solutions.

To gain that understanding, the students will be working with the Jai Bhagirathi Foundation (JBF), an organization that oversees these villages. As such, it is geared toward the “ecological, economic and social revival of the region,” according to its website, as well as instituting community ownership and empowering villages to take part in enacting these changes.

One of JBF’s major tenets is developing a water management system that provides clean, fresh water to all villagers. Since rains in the Thar Desert produce only 20-50 centimeters per year, “sweet” water (as opposed to saline) is a precious resource, and often hard to come by.

As this is Northwestern’s preliminary foray into the Rajasthan region, the trip is largely exploratory: what are the problems villagers are currently facing? What secondary problems follow? Which solutions have been tried, and which have not? Perhaps most importantly, what are the primary health concerns?

Diarrhea is a big one.

“A lot of the population doesn’t even know that diarrhea is a problem because they’ve never known anything else,” said Glucksberg. Yet it can be fatal.

Plus, the poverty there is unimaginable, said Kimberly Gray, a McCormick professor of civil and environmental engineering who shares oversight duties with Glucskberg.

The list goes on: water salinity, infectious diseases, bacteria, and fecal runoff from animals and humans.

And all of these problems have been exacerbated by recent population changes.

“These families have lived there for literally hundreds of years and have worked out a very fragile but sustainable relationship with the environment,” said Michael Diamond, an adjunct professor in Northwestern’s biomedical engineering department and president of World Resources Chicago.

Recent government intervention, however, has meant a significant reduction in infant mortality ate. This in turn has meant an exploding population, which the water table is having trouble coping with.

“Our students are starting to do the assessments,” Glucksberg said. “They’re going out to the villages, going to take the samples and do a catalogue to see what the extent of the problem is at this snapshot in time.”

Hopefully these assessments will, over time, provide opportunities to offer solutions. But that is not the main goal, Gray cautions.

“This isn’t just us helping them,” she said. “It’s them helping us in our educational mission.”

Glucksberg concurred, adding that the real goal of the program is student learning. “How do you make your idea stick, and not just leave a bunch of junk in a box?” he said.

Nonetheless, both professors have high hopes for the program.

“My greatest hope is to really develop a long-lasting partnership with JBF such that we can really develop a collaborative learning exchange program,” Gray concluded.

The students in Rajasthan are currently unreachable due to their remote location, but they will return later this summer. Please check back for an update on their progress and an inside look at some of their successes and challenges.

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A Map to Health, Happiness and Long Life

Michael Diamond (r.), here with other members of Northwestern's McCormick faculty, works hard to develop methods of ensuring the health of people at home and around the world.

Michael Diamond’s healthcare debate is a lot simpler than the one in Washington. For him, it boils down to one main question: how do we get available services to people right here at home?

“One of the biggest problems in Chicago is the tremendous disparity in health, not only in terms of outcomes, but also in terms of access,” said Diamond, who is an adjunct professor of biomedical engineering at Northwestern University. His solution to the access problem?

Community health asset mapping.

Though it might sound like jargon, this is actually a simple term: locating and recording the sum total of a community’s health resources.

“It’s not clear where people can go to access their health information,” Diamond said. Many people, especially those of lower socioeconomic status, are not only unsure about where to go on a cash basis or to use Medicaid: they are unsure about where to go at all.

Asset mapping has the potential to provide that information by putting it into a single, accessible database, available to all users. At least, that’s the goal.

Right now Diamond is focusing on two pilot areas in Chicago: Albany Park and Austin.

With Northwestern students’ help and the use of geo-coding, a process whereby he plugs address information into a database, Diamond is slowly but surely building a picture of the combined community resources in these neighborhoods.

Heather Polonsky, an incoming senior and Global Health minor at Northwestern, has been working with Diamond for two years now and has taken an active role in the project.

“It’s about raising awareness about resources that already exist rather than creating new resources,” said Polonsky, who worked in Albany Park to catalogue not only medical offices and hospitals but also grocery stores and pharmacies. Anything with bearing on community well being was recorded.

Polonsky also created a survey, to be distributed this fall at locations belonging to Healthy Albany Park, a community coalition. Its intention is to find out how community members use their services, satisfaction with those services, what they perceive as the most pressing issues in the neighborhood and how they meet a broad variety of health needs.

“Instead of a top-down approach, it’s more of a bottom-up,” explained Polonsky, who said that she’s enjoyed working with Diamond and was glad for a chance to apply what she’d learned in class.

As President of World Resources Chicago, a consulting firm that helps businesses and organizations respond to global challenges and opportunities, and the 2011 recipient of the Institute of Medicine of Chicago’s Public Service Award, Diamond is uniquely suited to combining community and medicine into a functioning whole.

The success of his projects so far relies largely on his cooperation with students, medical professionals, and community and citywide coalitions.

“Michael Diamond has done a tremendous job of organizing and leading numerous constituencies and groups of individuals towards wellness,” said James Galloway, Assistant US Surgeon General.  Through his work with Building a Healthier Chicago, a group dedicated to improving health citywide, Galloway has had ample time to assess Diamond’s contributions.

“Our work has been to expand great work throughout Chicago whenever we see it,” Galloway said, adding that Diamond has been crucial to these endeavors.  “We’ve been pleased to work with him and assist whenever we can.”

Diamond’s success is also a product of his approach.

“In addition to the technology, we have to remember the human element,” Diamond said. “The technology is there to help humans, has to be used by humans, and maintained by humans.”

In other words, if it isn’t working for people, then it isn’t working at all.

Someday, Diamond hopes to have a fully functioning system that will allow people to see the full picture of their health choices. Ideally, this will encourage people to get regular checkups instead of just going to emergency rooms in a crisis, to take their dental health seriously, to eat more nutritiously and exercise, and to fully engage with the health of their families and community as a whole.

Until then, and almost certainly after, Diamond’s work continues.

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NU students help shape the future of Evanston public health

Rebecca Wurtz

Public health in Chicago is not getting better, according to infectious disease expert and Northwestern University associate professor Rebecca Wurtz. But in Evanston, change is on the horizon, thanks to a recent partnership between Wurtz’s Introduction to Public Health class and the Evanston Health Department.

Wurtz, who served as president of the Chicago Board of Health from 1999-2002, proposed the partnership with Evanston’s health department last winter, as a practical and hands-on experience for her students.

“Part of what this course is about is to get students, whether they go on in public health or not, to be aware of the role of government and individuals in the community in promoting health,” Wurtz said.

In the previous school year, her students had worked with Northwestern’s student health service to define some issues that they wanted to learn more about among the undergraduates. The success of the project prompted Wurtz to take the idea to the next level.

“I knew that the Evanston Health Department was understaffed,” she said. “So, I thought maybe we could do the same sort of community health assessment on behalf of Evanston, and the students could have the experience of really working in public health.”

Every five years, the health department draws up a plan to address issues in the Evanston community, such as chronic disease, substance abuse and mental health. For the current plan, the city created a survey to collect data about community perceptions and needs.

Wurtz’s students analyzed this data, researched national trends, and identified community resources. They then proposed ways to address Evanston’s health needs in the future, such as creating Facebook pages, websites and maps, which are in the process of being published.

“The students came in with a good world health background, but not as much local experience,” said Carl Caneva, division manager for the Evanston Health Department. “So, it was eye-opening for them, and good for us to have people from outside the organization looking at this for the first time.”

Recent graduate Jay Shiao, who minored in global health, took Wurtz’s class after a friend recommended it.
“It was very applicable, very hands on, and it helped us apply what we had learned in all these public health classes to a very current situation in public health,” Shiao said.

The 21-year-old plans to pursue a master’s degree in public health, and is in the process of applying to medical schools. Because of Wurtz’s class, he is also working part-time for Cease Fire, a violence prevention organization run by UIC professor and epidemiologist Gary Slutkin.

Wurtz said this coming school year she will work in conjunction with professor Elizabeth Barden to create an even greater partnership between Northwestern students and the Evanston Health Department.

“[Barden’s] students’ job in the fall quarter will be to assess a problem in the community, and then my students’ job in the winter quarter will be to propose solutions and to actually create some versions of those solutions,” Wurtz said. “We’re trying to make it interesting and relevant for students who take either class, or both, and to actually give Evanston a more sustained service.

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Tracking HIV: a Q&A with McCormick’s Benjamin Armbruster

To the layperson, worldwide reports about the HIV/AIDS epidemic grow increasingly grim. But Benjamin Armbruster, an assistant professor at the McCormick School of Engineering and Applied Science, believes that good old-fashioned math can help solve problems of identification, treatment and prevention. A believer in the healthcare applications of engineering since grad school at Stanford, Armbruster focuses on HIV issues around the world, including Africa, India and right here at home. His most recent paper – accepted this week and available on his website – takes a look at HIV case-finding in sub-Saharan countries.

What is contact tracing?

Contact tracing finds you infected people: once you know somebody’s infected, you interview them about their sexual partners and try to follow up with them about getting tested.

Finding infected people is great because one of the big problems in Africa is that not enough people know their status. That’s part of the story of how it’s getting transmitted: people just don’t know they have it. You can only treat the people that you know are infected.

Right now screening programs rely on people to come to them.  What are the benefits of this new idea?

It’s somewhat surprising that contact tracing might be a good idea because in these African countries, the prevalence of HIV isn’t that low. You’d think that having or expanding a testing program is a pretty reasonable thing to do. If, say, you have a testing site in Malawi (prevalence is around 10 percent) and random people come to your testing site – not really the case, but a decent idea – then one in 10 will test positive. Whereas if you do contact tracing, first of all you have to interview the people. Asking people who their sexual partners are is not easy. Second of all you have to find them, so it’s not obvious that this is a cheap way of going about things.

What makes this interesting is it turns out that the chance a sexual partner is infected is extremely high. So that kind of mitigates the increased costs – instead of a one in 10 chance, it’s like a one in two or so. So we’re quite excited that this might be something people want to try in the future.

How would this be better than current approaches?

With the screening program, at least to some extent, people get tested because they’re sick. Once they’re sick, it’s pretty late. In the early stages is where treatment helps the most. Treatment reduces their viral load, makes them less infectious, and averts secondary infections. They’re not spreading it.

You have a lot in the pipeline right now. What are some of the other ideas you’re looking at?

How frequently people should get tested for HIV. How HIV is spreading among gay men in India, and making predictions about how that’s changing over time, as the sexual roles become more fluid. How diseases are spreading on networks and how the network structure affects that spread. There are big problems – a lot of them – and I end up working on pieces of them.

What are the engineering aspects of all these projects?

There are a lot of prospective things where having a mathematical model either really helps, or is the only way you can do it – these are things where you wouldn’t want initially to do a clinical trial. Either the trial can’t answer your question or it would be expensive to do that.

The other way engineering comes in is the focus on costs: not only does this idea work, is it cheap? So for instance, with contact tracing, there’s a real focus on thinking, “What is the most cost-effective way of finding people that are infected?”

What still needs to happen?

Money helps. The other thing that would really help would be decreases in new infections, so some prevention programs that are really successful. What the money is doing is getting treatment to a lot of people, which is great. What it’s not been as successful at doing is decreasing the number of infections, and if you want to get stuff under control and decrease the prevalence of HIV, that’s really important.

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