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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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Q&A with CARE’s Steve Hollingworth

From flooding in Pakistan to earthquakes in Haiti and upheaval in the Middle East, there isn’t much in the evening news to fill folks with hope for the future.  But Steve Hollingworth isn’t afraid to roll up his sleeves and get to work on a solution.  As COO of CARE, an international humanitarian organization, Hollingworth organizes CARE’s fight against poverty in 87 countries—tackling everything from microfinance initiatives to HIV/AIDS education.  The Elgin, Illinois native visited CARE’s Chicago office yesterday and shared his insights from more than 26 years with CARE.

What sparked your interest in humanitarian work?

As an undergrad at Augustana College in Rock Island, Illinois, I studied abroad in South America—it was the first time I’d flown in a plane or gone south of Champagne.  It had a big impact on me. I was shocked to experience abject poverty, but also as a younger person I was kind of angry that I wasn’t as knowledgeable or involved as I wanted to be.  My mom said when I came back from South America, she knew I had changed because I didn’t want to take showers—I didn’t want to waste water. At that point, I became very interested in issues of global poverty.

What is CARE’s strategy for organizing relief efforts?

There are three things that guide CARE’s work.  The first is to address human condition problems, such as health, education, income and asset formation. In the life of a very poor person there’s a deficit of some area, and everything we do has to address that.

The second critical thing is addressing the underlying causes of poverty—basically the social or political constraints that very marginalized groups face. People are poor because of social, cultural and political reasons, as well as economic or educational ones. So we really have to address a combination of concrete problems and do so in ways that give marginalized groups an opportunity for leadership and personal growth.

The third area is influencing the enabling environment, or making sure governments, institutions and financial markets are supporting the needs of the poor. We have a very active constituency and advocacy group here in the US to lobby Congress and businesses about those issues, and we also work closely with a wide range of partners in the developing world on government and business action to make sure the voice of the poor is heard.

How does CARE operate in challenging environments, such as the Middle East?

Community support is our biggest guarantor of safety when we’re working in unstable environments where there’s a lot of political unrest and the threat of tourism.  It also gives us much greater reach and the ability to sustain the work for longer.  If the communities value what we bring in, they become our biggest advocates.

Of CARE’s 11,000 employees, 98 percent are nationals of the countries that we work in, and they understand the cultural contexts very well. No one in CARE travels with arms or security—it’s really the goodwill of communities that allows us to continue to operate safely.

How can young people get involved in humanitarian efforts?

There are tremendous opportunities right now for folks to get involved.  I would encourage people to try study abroad.  That really changed my worldview. Many universities also offer courses that deal with international development, international affairs and public policy. Peace Corps is another major opportunity—it’s probably the most common way folks get their foot in the door at CARE. Another approach is to do a little crystal ball gazing about frontier issues, such as the impacts of climate change, water issues and social enterprise (addressing problems of the poor in a sustainable way). If people are thinking about future trends in the world, they can develop a skill set to address them.

Other resources include:

Ideaslist.org – a directory of volunteer opportunities

The Rotary Foundation– a foundation that offers scholarships to study abroad

One Campaign– grassroots advocacy and campaigning organization

Care Action Network–  an advocacy group of CARE supporters

Young Professionals for CARE– group of young people dedicated to supporting CARE’s mission

 

What are the biggest risks to global health?

There are two areas of poor performance, and they both don’t get a lot of attention.  Maternal mortality is a particularly difficult problem to solve.  It’s basically an acute problem on top of a chronic one. Mothers need good medical care at the time of delivery, and then there’s the long-term problem of women’s status in the community–often they have little control over the timing and number of childbirths. Maternal mortality in many countries is 60 to 80 times greater than it is here.

The other one is sanitation. There’s a relationship between poor sanitation and malnutrition.  Poor nutritional status is really at the core of any health issue—particularly children’s health.  They’re more vulnerable to any kind of infectious disease because of poor nutrition and adding poor sanitation just compounds the issue and leads to high levels of child death.

Any final words?

Foreign aid is insignificant in the US budget—much less than 1 percent.  But oftentimes it’s the first target in budget reduction. The upside of it is huge, and it’s a bad signal if we disengage from solving the problem of world poverty.

There has been a lot of soul searching in the US about the responsible posture we should take as a country toward humanitarian aid.  And I sense there’s growing sentiment that we have to be more engaged in world issues, such as climate change and poverty.  Our national values tell us to be engaged.

 

 

 

 

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Haitian ensemble Boukman Eksperyans energizes Northwestern’s Pick Staiger Concert Hall

Haitian ensemble Boukman Eksperyans energized Northwestern’s Pick
Staiger Concert Hall earlier this month with their Grammy-nominated
blend of Haitian, Caribbean, rock and reggae rhythms. The audience
waved Haitian flags donated by the island’s embassy, a vivid reminder
of the concert’s international focus as part of Passport: A Musical
Expedition, Northwestern’s 11-day tribute to sounds from around the
world.

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Journeys through an African medical school

In a time when so many Americans wonder what our healthcare system will look like in a couple of years, it’s also important to consider what it will feel like. In some instances, it often seems doctors have thrown their bedside manners out the window, acting more like mechanics working on broken machinery than human beings treating patients.

That’s when “illness becomes a mater of biology,” said Claire Wendland, a doctor and an anthropology professor at the University of Wisconsin. Wendland, who has spent several years studying the concept of medical socialization, is trying to understand the shift in mindset that occurs in North American medical students between the time they enter medical school, to when they graduate.

“Students quickly learn to accept death,” she said. Many students enter school as a heterogeneous group with a common idealism, but what happens is what she describes as a “blending process,” often even dressing alike. And, “by the time they finish medical training,” she said, “they have increased cynicism.”

The notion of medical socialization, Wendland explained, had only really been studied in North America and Western Europe, so she set out to Malawi, located in southeast Africa, to see if geographic location, culture and wealth play a role in the development of this mindset.

It is an understatement to say that a hospital in Malawi is different from one in the U.S. According to Wendland, in Malawi, nurses earn $3 a day, and medical interns earn $4. It was not uncommon at Queen Elizabeth Central hospital to “run out of soap, iodine or Tylenol” she said.  Additionally, public hospitals in the U.S. tend to have a 75 percent occupation rate, while Queen’s rate was about 150 percent, with patients often lying on the floor.

Wendland spent a total of about a year and half living and working in Malawi. She noticed that students there often studied the same text books as American medical students, in fact some of the same books she studied while earning her M.D. at Michigan State University, but the difference was that with a frequent shortage of supplies, they could rarely put their education to use. So instead, she said, “they expanded their definition of what they could give to the patients.” Perhaps they could not give them Tylenol, but they could give them love.

Malawi doctors showed less detachment from their patients than American doctors and shared the “we are all humans” perspective, she said.

In Wendland’s first book, “A Heart for the Work:  Journeys Through an African Medical School,” she shares her experiences working both as a doctor in Malawi as well as an anthropologist. And one question that remains unanswered in Wendland’s mind is: “If poverty has an impact on our practice, does wealth?”

Claire Wendland shared her experiences with Northwestern University students on February 23.

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Tracy Kidder: Journalist and Advocate

Paul Farmer holds a number of impressive titles – most people would feel fulfilled with just one. It takes five full scrolls to reach the bottom of his biography page on Harvard’s website.

*courtesy of Lyceum Agency

To name a few, he is Chair of the Department of Global Health and Social Medicine at Harvard Medical School and founder of Partners in Health – a non profit, which most recently is best known for its work in Haiti.

He is also the inspiration for, and central character in, Tracy Kidder’s 2003 book “Mountains beyond Mountains: The quest of Dr. Paul Farmer: a man who would cure the world.”

Kidder addressed students, faculty and community members on Thursday at the newly renovated Harris Hall on Northwestern University’s Evanston campus. He discussed – and promoted – his book as well as the work of Partners in Health.

In a graphic – and slow paced – slideshow, Kidder showed static images of the mal-nourished and extremely ill children Partners in Health has been helping over the years.

Kidder met Farmer in 1994, he said

“I like that he has that unique relationship [with Farmer] because most journalists don’t,” said Ryota Terada, a freshman at Northwestern University who read the book this summer as part of his assigned reading.

Kidder’s book was selected as this year’s One Book One Northwestern – a “campus-wide program that brings students, staff and faculty from across campus together around a single book,” according to the university website. “The project builds community at Northwestern by promoting conversation and collaboration across disciplines and schools.”

The university purchased 2000 copies of his book, President Morton Schapiro said.

But this isn’t the first time Kidder writes about Farmer. In 2000, he published a profile of him in the New Yorker. With a biography as long as Farmer’s, he is undoubtedly a busy person who is consistently on the go.

Many of the magazine’s female readers held a similar view of the piece, and they let Kidder know. In their letters, they often first acknowledged that Farmer was indeed an amazing person, followed by, “but I wouldn’t want to be married to him,” Kidder said.

Kidder couldn’t help but finally think: “I didn’t know he had proposed?”

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