Bethany Hubbard

1. NU-AID establishes new site in Oaxaca

   December 7, 2011 by Bethany Hubbard
   

   The Oaxaca team at a weekly lecture on global health issues wearing their new brigade-vests for the upcoming fieldwork. (Muthiah Vaduganathan - bottom row, first from left, Mania Kupershtok - bottom row, first from right)

   For more than 10 years, the Northwestern University Alliance for International Development (NU-AID) has been sending medical students to Latin America to provide care for underserved populations. This past summer, for the first time, 10 students traveled to Oaxaca, Mexico to establish a new project site.

   “Prior to this trip we were going twice a year to Nicaragua,” said NU-AID board member and second year medical student Pedro Engel Gonzalez.

   Gonzalez, who helped plan the Oaxaca trip, said the site was chosen after they were given the challenge of finding a location where students could not only stay longer, but also work within the country’s medical system.

   “We decided that the Oaxaca trip provided a similar opportunity to what we were doing in Nicaragua – working with an underserved population and tropical medicine,” he said, adding that the Oaxaca trip lasted a month, significantly longer than the week-long Nicaragua trips.

   NU-AID partnered with Child Family Health International, a U.S. non-governmental organization, started many years ago by a Stanford student who wanted to provide more opportunities for medical students to work in global health in a sustainable way.

   Muthiah Vaduganathan, a fourth year medical student, was a member of the 10-person team that traveled to Oaxaca

   

   Public health "platica" (or lecture) attendees holding up their mosquito nets donated by the medical students.

   this past summer.

   “I was looking for a good opportunity to see real kinds of international health issues and have a global health experience,” he said. “We were able to see many clinical situations that we wouldn’t get to see in the United States.”

   The first two weeks students worked in several different clinics with local physicians. Vaduganathan said Dengue fever, a virus transmitted by mosquitos, and Chagas disease, also spread by insects, were a few of the illnesses students saw at the Oaxaca clinic.

   The second two weeks were devoted to public health issues. Vaduganathan’s team addressed the high maternal mortality rates. They spoke with midwives and 40 local women about contraceptives.

   “This is the first time they were being exposed to health workers from abroad,” he said. “We were able to integrate our talks into their existing system.”

   Mania Kupershtok, a second year medical student who was another member of the Oaxaca team, went on a previous NU-AID trip to Nicaragua. She said the Oaxaca trip was another great service-oriented opportunity.

   “They have a really strong public health foundation,” she said, citing Oaxaca’s Opportunidades program, which the NU-AID team worked in tandem with. “I was surprised at how well they are currently doing. In the poorest areas everyone was still very educated about diabetes, hypertension – even down to how it works in your body.”

   Though there is always room for more education, Vaduganathan said the people of Oaxaca are doing well with what they have.

   “Although resources and money really limit a lot of the overall care, I think with the resources they have, the Mexican health care system was actually very efficient in terms of how they utilized those resources,” he said. “Their care for every day issues was excellent.”

   Gonzalez said NU-AID plans to return to Oaxaca next summer, and though he won’t be able to join the trip then, he hopes to participate in his fourth year.

   “How to reach out to underserved populations globally is a hard topic right now,” he said. “Hopefully we’re going to be sending a trip every year.”

   Learn more about NU-AID: http://groups.northwestern.edu/nuaid/

   Related posts:

   1. Global Health students work to perfect technologies that aid in kangaroo mother care
   2. A Q&A with Weinberg’s Thomas McDade
   3. A Q&A with McCormick’s Dirk Brockmann
   4. NU students unite for global health
   5. Northwestern students advocate access to treatment on World AIDS Day

   Category: Child Health, Community Health, Global Health Initiative, Global Initiatives, Infectious Diseases | Tags: Mexico, NU-AID, Oaxaca | Comments (0)

2. Initiative addresses maternity care concerns in Tanzania

   October 31, 2011 by Bethany Hubbard
   

   Dr. Crystal Patil with traditional birth attendants in Tanzania, where she has been studying maternity care at the Haydom Lutheran Hospital. Photo courtesy of Dr. Crystal Patil.

   Imagine being pregnant, without a car and more than six miles away from the nearest hospital. This is the reality for many women living in rural north-central Tanzania. As a result, giving birth can be dangerous and even fatal. But, global public health agendas, like the Safe Motherhood Initiative and 2015 Millennium Development Goals, have been inspiring change.

   In 2008, the Haydom Lutheran Hospital, in the Mbulu district of the Manyara region of Tanzania, began offering free ambulance and maternity services in an effort to reduce maternal mortality rates.

   Biocultural anthropologist Dr. Crystal Patil, who is an assistant professor of Anthropology and African American Studies at UIC, has been studying the effects of the policy changes at the Haydom hospital. She presented her research to students in Northwestern University’s Program of African Studies, as part of the program’s “Public Health in Africa Series.”

   “Some social and economic barriers were removed by this policy,” Patil said. “But, the changes in the policy may have had an impact on the quality of care.”

   The Haydom policy change has been effective with 4,558 hospital births reported in 2008, up from 3,343 the previous year. In addition, 94 percent of those who live less than two kilometers from Haydom gave birth in the hospital.

   However, there are many factors still keeping women at home when they give birth, and several challenges preventing the new system from

   

   Ambulance driver dropping off a laboring woman to the maternity ward at Haydom. Photo courtesy of Dr. Crystal Patil.

   running smoothly.

   Patil and her team conducted interviews and surveys, and held village meetings. They spoke with mothers, hospital workers and traditional birth attendants.

   Women said gossip, perceived discrimination, social support, transportation and sudden labor are some of the many factors that influence where they choose to give birth. Often the reason was simply, “Huwezi kupanga,” which means, “You just can’t plan.”

   But, even if planning is possible, once a woman reaches the hospital, she may not receive a nurse’s care because Haydom is severely understaffed.

   “So if the woman comes in and she looks OK, they have her labor by herself and deliver by herself,” Patil said. The nurses feel they can’t perform their jobs properly because it’s physically impossible.

   Because of this, nurses can’t accompany ambulance drivers, who already face poor road conditions and difficulty locating homes.

   “The ambulance drivers aren’t trained to provide healthcare services,” Patil said. “They’re mechanics, so they’re not comfortable going to pick up a laboring woman.”

   Though the policy changes have given women more support, there is still a long way to go. Patil said women want to be treated well even if the care they are receiving is free. But, with so few options, it is hard to make a case.

   “People don’t have choices,” Patil said. “You have to go to the closest one, so choosing a hospital based on quality of care is impossible.”

   Jessica Pouchet, a first-year graduate student in anthropology, came to Patil’s talk because she will be doing her fieldwork in Tanzania, studying the connections between language and environment.

   “One element that resonated with me was how the distance from the hospital affects women’s decisions on where to give birth,” she said.

   Even as distance becomes less of an issue, such policy changes need to be matched with changes in staffing, said Patil, who heads to Malawi on Friday to work on a group antenatal care project. Until then, women’s hospital birth experiences may be compromised if such quality of care issues are not addressed.

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   2. Global Health students work to perfect technologies that aid in kangaroo mother care
   3. Reporting from the 3rd Annual Clinton Global Initiative University 2010
   4. Q&A with CARE’s Steve Hollingworth
   5. Good manners and common sense: Charity founder addresses Feinberg students at benefit for Pakistani flood victims

   Category: Global Health Initiative, Global Initiatives, Tanzania, Women's Health | Tags: hospital, maternity, pregnancy | Comments (0)

3. NU students unite for global health

   September 14, 2011 by Bethany Hubbard

   
   

   On Wednesday, Sept. 7, Northwestern medical students came together to share their work in global health with colleagues, peers and professors. At the Feinberg School of Medicine’s Global Health Poster Session, students presented posters that showcased projects from around the world, and offered first-year med students a glimpse of what they too can achieve in the future.

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   2. From Idea to Innovation: Insights from the 2012 Global Health Unite for Sight Conference
   3. Northwestern students advocate access to treatment on World AIDS Day
   4. NU students help shape the future of Evanston public health
   5. Northwestern sends team to Emory’s Global Health Competition

   Category: Chicago, Community Health, Ghana, Global Health Initiative, Global Initiatives, Public Health, Women's Health | Tags: Chicago Lakeshore Medical Associates, Feinberg School of Medicine | Comments (0)

4. A Q&A with McCormick’s Dirk Brockmann

   August 29, 2011 by Bethany Hubbard
   

   Dirk Brockmann is revolutionizing the way we track infectious diseases.

   Dirk Brockmann, an associate professor in the Robert R. McCormick School of Engineering and Applied Science, is changing the way we track the spread of human infectious diseases. He uses modern technology, such as social networking websites, to examine human mobility. His work, with colleague Lars Hufnagel, analyzing data collected from the website Wheresgeorge, which tracks the geographic circulation of individual dollar bills in the United States, was key in developing reliable models for pandemic disease forecast.

   What is the focus of your research?

   The broad picture is that we are focusing on understanding complex systems. One example is the spread of human infectious diseases. We’re using mathematical models to try to understand these phenomena better.

   Related to this is research on human mobility. Nowadays there are all these devices that can track where we go, such as iPhones or GPS devices, and there are lots of social network websites that collect data.  We can potentially understand patterns behind infectious diseases by using mathematical models or methods from theoretical physics to look at this data.

   If you want to understand how H1N1 spreads in the U.S. there are basically two things that you need to know: how humans interact (because interactions lead to transmissions) and how people travel. If people are not traveling the disease cannot spread from A to B, and if people are not interacting the disease cannot proliferate in a population.

   How is modern technology changing the study of infectious diseases?

   Prior to the onset of pervasive data collection – data that is being collected on the Internet and by modern devices – we had to really guess about the underlying rules that govern our mobility patterns and interaction patterns. It was all based on intuition. Now we’re in this transition phase where we can collect all this data and measure how people interact and travel, and then use that to refine our models of disease dynamics.

   Before everyone had a cell phone, we had the idea that if we know how people travel we can develop good models. But we didn’t know how people travel and we didn’t measure it. We had the intuitive notion that of course you travel short distances more frequently than long ones, but exactly how much?

   We came across the Wheresgeorge website and thought that maybe we could see a trace of how humans travel by looking at how the money goes from A to B.

   How did you implement these techniques when studying recent epidemics?

   In 2004 we were asking ourselves, “Can we develop models that can predict the spread of a disease like SARS in the same way that you can make a weather prediction?” You can say tomorrow there’s going to be a 60 percent chance of rain and often that prediction works very well for a certain period of time. So the idea was to do something similar for emerging infectious diseases.

   Then H1N1 came and we gathered data the first few days and started running these simulations and made predictions. For a few weeks it was very good and then it diverged, which was insightful. Just like a weather forecast, it works for a couple of weeks and then something else happens and you can no longer make a prediction.

   The main reason was because people started reacting to the disease. What these models can do nowadays is only compute the worse case scenario, where no one does anything to contain the spread of the disease or people do not change their behavior. We have no way of incorporating this into a model yet.

   That’s the big subject of the future – trying to understand how people react to the news of a disease.

   What are you currently working on?

   We’re trying to not only incorporate mobility behavior and social interactions, but also trying to understand how they change in response to such events. One way to understand this is to investigate how individuals change their communication patterns in response to large-scale events, like a bomb threat or earthquake. People start behaving differently on their social network sites and one can use that information as a model for how we change our interactions.

   In many of these models, complex networks play a role. Many complex systems can be understood in terms of individual units or parts interacting in a network structure. Best example is a social network, where every individual is a node and a social tie is a link.

   Imagine there is news spreading through some sort of social network. There are some people that have lots of connections – friends and peers. Then there are some that only have a few, and there are those who bridge one peer group with another.

   You can imagine that news spreads in one group and then suddenly gets to the person that is functioning as a bridge and then it will get to the other group. Those people who have lots of connections are super spreaders in that they spread the news efficiently.

   How do you apply this to human mobility?

   If you visualize the worldwide air transportation network, the nodes are airports and they are connected by links. Some links are very strong, like New York and Chicago – they have a very strong link because lots of people travel between them.

   If I run the simulation of an epidemic and I show this to you on a map you will see the hubs, such as Los Angeles, New York and Chicago, will get infected very quickly because lots of people live there and these places are very well connected.

   Compare this to the spread of the Black Death in the 14th century, which started out in southern Europe and went like a wave over the entire continent. People didn’t travel long distances at that time, so it just went a step forward and infected the next villages and so on. It’s not like that any more.

   Why now?

   Infectious diseases are not very old. The reason they could not be sustained in early human populations is because it wasn’t dense enough. Most of these viruses come from animals that are swarm animals, or exist in large populations, such as birds or cattle. For transmissible diseases you have to get two populations really close to each other in order to sustain it. So it was not a surprise that human infectious diseases emerged when large civilizations started to emerge. Ever since then the emergence rate of new disease has increased.

   We now live in very dense situations and that facilitates the emergence and spread of new diseases. It’s an ongoing battle between the emergence of these diseases and us understanding better the way we interact and travel. So the better we understand this, the better we can contain a disease or mitigate the spread. It’s not like this problem is going to be solved very quickly. That’s the biggest challenge.

   Learn more about Prof. Brockmann’s work here.

   Related posts:

   1. Halting pandemics in their tracks: EpidemicIQ
   2. A Q&A with Weinberg’s Thomas McDade
   3. ‘Contagion’ echoes the reality of public health outbreaks
   4. NU-AID establishes new site in Oaxaca
   5. Global Health students work to perfect technologies that aid in kangaroo mother care

   Category: Community Health, General, Global Health Initiative, Global Initiatives, Infectious Diseases, Public Health | Comments (0)

5. A Q&A with Weinberg’s Thomas McDade

   July 15, 2011 by Bethany Hubbard
   

   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.

   Related posts:

   1. A Q&A with McCormick’s Dirk Brockmann
   2. Northwestern students advocate access to treatment on World AIDS Day
   3. NU students unite for global health
   4. NU-AID establishes new site in Oaxaca
   5. Halting pandemics in their tracks: EpidemicIQ

   Category: Bolivia, Chicago, Community Health, Global Health Initiative, Global Initiatives, Infectious Diseases | Tags: biological, biomarkers, Philippines, physiological, Samoa | Comments (0)