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Bringing safe water to the desert: A Q&A with Susan Vescovi

Women carrying water on their heads through the arid desert landscape. Photo courtesy of JBF (www.jalbhagirathi.org).

At the beginning of July, Roshni Barot , Susan Vescovi and Tracy Yang arrived in India’s Thar Desert to work with the Jal Bhagirathi Foundation (JBF). Master’s students in the Global and Ecological Health Program, the three hope to help assess water quality in the 140 villages served by the foundation. As part of Northwestern’s biomedical engineering program, the exchange fosters problem-solving and collaboration, and gives students hands-on field time to hone their analytical and engineering skills.  Though students cycle through one term at a time, the partnership between JBF and Northwestern will hopefully remain for years to come, and as the first students welcomed by the foundation, Barot, Vescovi and Yang fill an especially important role.

Though busy, Vescovi took time to answer questions for the Global Health Portal on behalf of herself and her fellow students.

 

How would you describe your surroundings and your new colleagues?

We are currently staying at the Water Habitat Retreat at the JBF, where we are working on our project. It is about 20 minutes away from the city of Jodhpur, so we haven’t had a lot of time to be in the city around local people. Our new colleagues are very nice and have been trying to set us up with all the information we need.

This phase of the project is largely exploratory – what does that mean?

We came into this project with a little bit of an understanding about the scientific work JBF is trying to establish here. We had an initial idea about the work we wanted to do, which was to draw a clearer connection between water quality and health. We did not have much of their scientific data before we came to Jodhpur, but after spending two weeks here we better understand the organization and the how they perform their water quality testing.

How has your past prepared you for this?

The three of us all have very diverse backgrounds. I have an undergraduate degree in biology, Tracy has a undergraduate degree in architecture, and Roshni has an undergraduate degree in biomedical engineering. It seems like we have all been able to deliver something different to the project, like drawing skills, past lab experiences, language skills, and general differences in looking at a problem. It’s really funny to see how all of our past experiences sort of click as we tackle this project!

What do you hope to get out of this experience?

I think we are all hoping to contribute to the efforts of JBF. They have done a lot of work with bringing people in the region water and now they want to make sure that the water is safe. Hopefully we can them help focus on different scientific factors that can monitor water and one day establish a strong collection system that can demonstrate the importance of clean water to the people they work with. We are also excited to be getting real hands on experience working with an NGO and seeing how they use scientific fieldwork to promote their efforts.

What do you imagine your contributions to this effort will be?

We are still working hard to find that out. The situation is not as clear-cut as we had originally imagined. We are still making a lot of observations that are important for future students who may continue our project in the future. Our contributions will most likely be laying groundwork for what is possible in the future and helping JBF to look at different types of testing that can form Northwestern student projects in the future.

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Researching the growing prevalence of diabetes and hypertension in rural Bolivia

Hola desde Bolivia!

We are Annsa, Danielle, and Gabby, and the three of us are recent Northwestern graduates, moving (perhaps a little too) quickly into the start of our M1 year at Feinberg. We are currently wrapping up our summer abroad in rural Bolivia, where we have been working with Centro Medico Humberto Parra (CMHP), a free primary-care clinic situated in the country’s eastern rainforest. CMHP is located in the small village of Palacios, about a 2 hour’s drive outside of the city of Santa Cruz.

To address the growing prevalence of diabetes and hypertension in the region, CMHP has recently established its own diabetes prevention and management program, which utilizes community health leaders to facilitate diabetes and hypertension support groups in their respective villages. However, the clinic faces a severe lack of data regarding the burden of diabetes in each individual community that it serves. After contacting health professionals at CMHP, the three of us identified a need for research on the prevalence of diabetes, hypertension, and other relevant risk factors in the clinic’s surrounding villages.

For this reason, the three of us have spent these past two months in Palacios, screening for diabetes and hypertension in four communities surrounding the clinic: La Arboleda, Buena Vista, Yapacani, and Warnes. With this research, we hope to provide CMHP with a broader, more comprehensive body of knowledge relating to the health demographics of its surrounding villages.

Our method consisted of conducting a brief interview with participants about their medical history, diet, general health and exercise habits, in addition to measuring height, weight, blood pressure and blood glucose levels. Because we had to measure participants’ fasting blood glucose levels (before they had consumed any food), most of our work was done in the early morning. We would wake up between 5:30 am and 6 am, always before sunrise, gather our materials and supplies, and head out in the clinic’s SUV. We spent about six mornings in each community, interviewing participants and collecting data.

We would arrive at our designated location within each community, which ranged from someone’s house to the sidewalk in the main market to the local health post. Our location changed every few days to increase exposure and reach a different group of participants. Sometimes, we would arrive at our spot and there would already be people waiting in line and other times, people would trickle in after reading our sign or seeing the crowd.  It was really astounding how people would wait in line for over an hour just to have their blood pressure and glucose levels measured!

We learned to work efficiently, with what resources and space we had. One table, a few chairs, one balance, a stadiometer to measure height, three sphygmomanometers, three glucometers, and a few boxes of lancets and test trips. Each of us would take one participant, explain the purpose of our study and start with the interview, ask our questions, measure weight, height, blood pressure and blood glucose levels.

Although all three of us speak Spanish, at times, it was still difficult to communicate with participants either because they did not exactly understand our questions (specifically related to the concept of chronic disease and exercise) or would use Bolivian slang and special words that needed further explanation, especially when it came to talking about diet and work. For example, a lot of our participants were amas de casas, or housewives, making it difficult for both them and us to judge how truly active their lifestyles were. After all, we’ll agree that running after small children and doing laundry by hand every day can be tiresome, but is it the same thing as playing fútbol or going for a run? That’s something for us to work out as we start analyzing our data. As a whole, however, it was great to talk to these people about their daily lives and habits, and we definitely became very familiar with the Bolivian lifestyle.

We talked to over 450 people and made lots of new friends, to the point where we would recognize people who had participated in our study. In La Arboleda, one of the women made us breakfast after we finished with our study (coffee, cuñapes, and quinoa cake). In Buena Vista, participants would return on the following days just to chat with us and see how we were doing. The local community health leaders in Warnes would treat us to salteñas, a typical Bolivian breakfast pastry. Meanwhile in Yapacani, the health leader’s adorable 2-year-old daughter, Sari, would come play with us when we were done working. We were even interviewed in two different communities by reporters and showcased on the nightly news, speaking our finest Spanish of course! Every place we went, we were welcomed by the community and graced with willing and friendly participants.

One of the early difficulties we faced while conducting our study was trying to explain the concept of chronic disease with our participants. For the most part, Bolivian understanding of health tends to be more immediate in nature, influenced by the belief that chronic diseases like diabetes can be cured with a single doctor’s visit. Even those participants who had been previously diagnosed with diabetes had trouble grasping the importance of consistently taking their medication as prescribed.

We encountered many patients who told us that they had diabetes and/or only took their medication when they “felt bad.” Many did not realize that diabetes is chronic, meaning it occurs from one year to the next and necessitated constant monitoring. We had to explain that it was not a disease that could be controlled sporadically but required taking medication daily to maintain a normal blood glucose level. If anything at all, our study served as an educational campaign in these four communities, as we were able to teach hundreds of people not only important steps to diabetes prevention and management, but the basic tenets of living a healthy and active lifestyle.

As we wrap up our time here in Bolivia, we can say with absolute conviction that this has been an incredible verano – an unparalleled learning experience that we will surely continue to draw from for the rest of our lives.

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21st Century Life in El Péten, Guatemala

by Laura Ruch, WCAS 2012, biology and science in human culture major, global health minor

Dr. Paul Farmer once said, at a keynote address for the 2010 Northwestern GlobeMed Summit, “There are no first, second, third worlds.  There is one world.”  That line has stuck with me since I first heard it, and I think it offers a wonderful model for thinking about issues related to poverty, access to resources and health inequality.   We are all living in the 21st century, a time of seemingly endless technological capacities, and as members of one world, it strikes me as unacceptable that some communities continue to remain cut off from the resources and inventions that the “developed” world has at its fingertips.

I recently had the chance to spend a week in El Petén, Guatemala, working  with an NGO called SewHope, based out of Toledo, Ohio (my hometown).   I’ve traveled to Guatemala five times before, but this trip rattled me even more so than the others, perhaps because I am older, but also, I think,  because the organization has developed strong relationships with the  people in Pueblo Nuevo.  The small village has only about 60 families, and  working among them, it felt like we were their extended family, their  friends, rather than outsiders with our own agenda.  SewHope is a  multifaceted organization comprised of physicians, teachers, farmers, and  students, both from the US and Guatemala.  While the American doctors  have expertise in diagnosing and treating illnesses, the organization would be nothing without the inside knowledge and connections of the Guatemalans who work there.  When we must board a flight back to the US, patients can return to the clinic for follow up visits and medication refills, the education programs continue to run, and the gardens and tilapia farms we helped to create aid in improving nutrition and bringing in extra cash for the community.  It seems intuitive that an organization working in community development and health care simply cannot be effective if it runs stop and go programs, dependent upon the travel schedules of foreigners.

Many incredible moments came out of my week in Pueblo Nuevo, but I’ll limit myself to sharing three of the most poignant stories.  Firstly, while taking a medical history of a young woman, I commented on her baby’s lovely knitted red hat, and asked her why she used it in the middle of the summer.  As it turned out, the hat was not for sun protection so much as  for protection from “El Ojo”, or the Evil Eye.  The woman explained to me that the year before one of her other children had begun vomiting a green fluid after a man she had an argument with gave it “the look.”  The baby died suddenly.  After hearing this, I began to notice that almost all the babies had something red on them – a shirt, a blanket, a simple bracelet.  Beliefs surrounding Evil eye date back to Spanish folk religion, and children, especially infants, are believed to be most susceptible.  In a setting where many infants die of malaria, diarrhea, malnutrition, and other preventable illnesses, it makes sense that such beliefs are ubiquitous.  Rationalizing “stupid deaths” (another Paul Farmer phrase) by ascribing them to uncontrollable forces of evil is a much easier pill to swallow then recognizing that one’s child has been the victim of an unfair world, where some are simply cut off from basic healthcare, sanitation, and clean water.   Many women also continue to believe that their health care catastrophes are the results of the “susto”.  Susto is what happens when you experience a terrible “fright.” One woman described seeing a large snake in her home that terrified her while she was pregnant, and her baby immediately died.  Another woman witnessed a murder and afterwards began experiencing chronic back pain. Of course, these are not conscious things – the mothers have not had the privilege of learning about the mechanisms of disease and malnutrition, and they are not trying to replace science with non science-based cultural beliefs.  However, one can see how believing in the Evil Eye or “susto” might serve as a sort of coping mechanism for painful losses.

Also on the trip, I saw first hand the importance of a community feeling  empowered and being able to collaborate to work toward big goals.  The  day after I arrived in Guatemala, we drove into the village in a van and found all of the kids and some of the community leaders gathered outside  the school and looking forlorn.  As it turned out, the school’s principal, Concepcion, had locked the gates to keep the students and teachers out. From what I understood, he felt angry at the way parents had been pushing him to create new education programs, and he thought that the  new spirit of empowering women and children would undermine his  authority.  He is frequently absent (the school was only open 1 day the  week before for no apparent reason).  Concepcion has been pulling these  sorts of stunts for years, but the community had decided once and for all they had had enough, and one of the leaders went off in search of something to break the lock with.  When he came back with a huge set of bolt-cutters, he spoke for a few minutes on camera about the unfairness of the situation, and then forcefully broke the lock while everyone clapped and cheered.  On July 1, a group of the villagers went to the Human Rights Commission, the Ministry of Education, and the newspaper (Prensa Libre) with the information, with the hopes of removing Concepcion from his position.  They were able to inform the authorities who have promised to replace Concepcion.  It was really cool to see the people of Pueblo Nuevo standing up for themselves and taking the initiative to demand a higher standard of education for their children.

Finally, a very surprising event that we were privileged to take part in was the excavation of the body of the husband of one of the women in the village.  The man and his friend were the victims of random killings during Guatemala’s 36 year civil war (1960-1996), arguably the most brutal civil war in the history of Latin America.  More than 200,000 people were killed, about 83% of Mayan descent, and the U.N. Commission for Historical Clarification has issued a report showing that state forces and military groups inflicted the vast majority of human rights violations.  Now the government has started a program to offer some solace to families of those who have suffered the loss of loved ones. A team of two archaeologists, two forensic scientists, a psychologist, numerous policemen and others led the exhumation of the husband and his friend. The story was featured on the Guatemalan news for the Petén region.  The community eagerly included us in the very special event and even invited us into the area sectioned off for family members.  Our friend Orfe initiated the process, and she has also established a cemetery in Pueblo Nuevo.  For a community with very strong religious beliefs, having a proper place to bury and visit those who have passed away is very important.

It took me a full day of traveling to make it back to Chicago, and, as  always, it was a somewhat surreal experience to step into an American  airport and have limitless restaurants, amenities, and services offered to me. The week in Guatemala truly flew by, and I’m eagerly looking forward  to my next trip there. In the meantime, there are lots of things to mull  over.  I can only imagine what sort of changes will take place in Pueblo Nuevo in the next couple of years and beyond the people are given the chance to make their lives better.

 

 

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Northwestern group helps bring fresh water to Honduras

Members of Northwestern’s student-led movement work in a Honduran streambed.

Getting a cool drink of water, especially at this time of year, is so automatic that most of us don’t even think about it.  It never crosses our mind that the glass is clean and the water is not only clear and tasty, but pure and safe.

Not everyone is so lucky, as the members of Global Water Brigades’ (GWB) Northwestern chapter know well.

“Unsafe water and lack of basic sanitation cause 80% of all sickness and disease worldwide, ending more lives every year than all forms of violence,” says their website.  It goes on to say that more than 90% of these deaths – 42,000 a week worldwide – are children under 5.

At Northwestern, students are doing something about it.

“Every year we fundraise money to take a trip of about 10-15 students down to Honduras,” said Ted Bakanas, co-chair of GWB’s Northwestern chapter and last year’s trip leader.

Why Honduras?

Because it is the poorest country in Central America, and lacks much of the infrastructure that more developed countries take for granted.

“Nearly one-fifth of the rural population does not have access to safe drinking water, and nearly half do not have proper sanitary facilities,” the website says.

Once down there, the group works with Global Brigades in-country staff to help rural villages without clean, running water build systems that will supply it in future.  Usually, Bakanas said, these systems are gravity-based.

Building the system itself is an intensive process that begins with an engineering orientation and a hike to view the village’s water source.  From there, students begin digging trenches, and threading and laying pipe.  Recently, the Northwestern chapter purchased its own pipe-threading machine.  Having a machine on-site to cut lengths of pipe and form the grooves that help them screw together is a huge benefit when doing the projects.

Fundraising is responsible for the pipe-threader, as it is for most of the costs associated with GWB.  Activism is also one of the group’s main pillars.

“We try and do different activism events to spread awareness of the water shortage issues in the world,” Bakanas said.  And these events aren’t limited to here in the United States.

“One of my favorite parts of the trip is the last day we do an education segment,” he said.  “GWB gives us a topic, usually dealing with water, like water and health, and we go into schools in the village and we teach the kids all about water safety and water sanitation.  It’s a fun time.”

GWB is just one offshoot of Global Brigades, an umbrella organization that encompasses medical, business, environmental, law and other branches as well as water, all non-profit. Global Brigades is in Central America, Ghana, Vietnam and India.

The Northwestern chapter is considering an expansion into Ghana in the future.

“But it’s a considerable price jump, so it’s something we’d have to talk about and plan for,” Bakanas said.

In the meantime, preparation for next year’s spring break trip is already underway.

Read more about Northwestern’s GWB here.

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A Q&A with Weinberg’s Thomas McDade

Thomas McDade is transforming the way biological data is collected abroad and in the U.S.

Thomas McDade, Northwestern professor and biological anthropologist, is revolutionizing the way population-based biological data is collected and studied.

Using biomarkers from finger-stick blood spot samples, McDade studies how social and physical environments affect immune function and inflammation, which contribute to the risk for disease. He is also the director of Northwestern’s Laboratory for Human Biology Research where such minimally invasive methods are being further developed.

His research, in places like Samoa, Bolivia, the Philippines and the U.S., is motivated in part by trying to understand how the circumstances in which people live their everyday lives affects their behavior and physiology.

In this edited interview, McDade talks about his research abroad, and how it will have an impact in the U.S.

Where are you currently working, and what is the focus of your work?

Now, my work is focused largely in the Philippines on a study that has been ongoing for almost 30 years. It began with the recruitment of pregnant women. They were interviewed, and their households and communities were surveyed. After they gave birth, both the mothers and babies were followed-up with on a regular basis for over 25 years.

We have a lifetime of information on the social and physical environments that these kids have grown up in, and lots of information about their health and their lifestyles. Now they’re having kids of their own, because they’re in their mid-twenties, and we’re following that next generation. So, we now have three generations in the study.

It’s a really unprecedented resource for understanding how prenatal and early postnatal environments affect the human life course, and human health and physiology, such as the regulation of inflammation in adulthood.

That’s also of particular interest in the U.S. because we’re coming to understand that inflammation may be an important contributor to cardiovascular disease, diabetes and the diseases of aging that we are concerned about.

If we can understand how environments early in life shape the regulation of inflammation in adulthood, we’ll have a better understanding of how inflammation functions, and how we can manipulate it in ways that help us prevent diseases from happening.

You work with biomarker data collection. How is this done, and why is it important?

Biomarkers work is the development and application of minimally invasive methods for measuring human physiology in non-clinical settings.

Right now our understanding of human biology and human physiology is based largely on research that takes place in clinical settings in places like the U.S. and Europe. It doesn’t typically happen in more remote community-based settings because the methods are not amenable to that kind of research setting.

By using saliva sampling or finger-stick blood spot sampling, we can collect biological specimens from large numbers of people at very low cost in remote places around the world.

Why are you using similar research methods in the U.S.?

Instead of relying on a subset of individuals to come to your lab or clinic, you can go to their neighborhood or home to collect blood samples.

So the exact same methods, saliva sampling and finger-stick blood spot sampling, which were developed for places like the Amazon basin, are being used here in neighborhood or community-based settings to understand how stress and diet, or other aspects of an individual’s neighborhood, matter to their health.

What are the main benefits of such data collection techniques?

They really reduce the cost associated with collecting the samples, but they also allow you to get information from a more representative sample of people.

If you want to do a study of how poverty affects health, it’s going to be harder to convince poor people in a really underserved neighborhood to come into Northwestern Memorial Hospital, for example, and give you blood.

But if you can go into their home or community center and just ask for a drop of blood from a finger stick, they’re more likely to give that to you. So you can get information from people who you otherwise wouldn’t be able to access.

Do you have any other projects in the works?

The study that I’m focused on in the U.S. right now is called the National Longitudinal Study of Adolescent Health. It includes over 15,000 young adults in the U.S. with about 15 years of information on their school environments, neighborhoods, individual levels of stress and depression, and the quality of their social relationships.

We have finger-stick blood spot samples from all 15,000 of those people. So it’s the largest ever research application of these methods, and really an unprecedented opportunity to gather rich information on the social and physical environments in which a group of people are living in the U.S. It provides an opportunity to link that information with objective physiological information.

Something else I’m studying, and will write some papers on this year, is why inflammation is so much lower in the Philippines even though they have higher levels of infectious disease.

I think it traces back to their early environments, and ways that the immune system develops in a certain microbial environment that allows it to regulate itself more effectively, and keep levels of inflammation lower in adulthood.

I think the work in the Philippines is a nice demonstration of the value of international comparative research, and how a human physiological system in a different environment gives us some insight into how that system develops and functions in the U.S.

Learn more about McDade’s work, and read recent publications, here.

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