Liveblog: 8th Annual Houston Global Health Collaborative Conference, Day 1

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2020 HOUSTON GLOBAL HEALTH COLLABORATIVE

On March 6, 2020, Alex Nuyda, Alicia Leong, Annie Zhang, Jake Lescher, Katherine Wu, and Samantha Chao, attended the eight annual Houston Global Health Collaborative symposium. These are their notes. 

Global Health Technology and Innovation 

1:00-1:55

Location: Research Institute, Houston Methodist Hospital 

Speakers: Melissa Varon, MS 

Jose Gomez Marquez 

Andi Gobin, PhD 

Moderated by Sharmila Anandasabapathy, MD 

RURAL HEALTH CARE

Melissa Varon is presenting on Project ECHO for cervical cancer prevention, examining the lack of access to specialty care for treatments in Hepatitis C in New Mexico. Most of the individuals affected were prison inmates. Hepatitis C is apparently difficult to treat–as difficult as chemotherapy, says Varon. In particular, Varon is demonstrating patient outcomes where individuals involved with Project ECHO (Extension for Community Healthcare Outcomes) decreased in their wait time from a few months into 2 weeks. 

Marc Arbyn et al., “Estimates of Incidence and Mortality of Cervical Cancer in 2018: A Worldwide Analysis,” The Lancet Global Health 8, no. 2 (February 1, 2020): e191–203, https://doi.org/10.1016/S2214-109X(19)30482-6.

Alex’s Notes:

  • Buckminster Fuller’s Knowledge Doubling Curve is very similar to Kurzweil’s theory of exponential growth of technology (law of accelerating returns)
  • Project ECHO has intensive focus on the distribution of knowledge from knowledge producers and “applicators” so to say
  • Project ECHO is the glue between various initiatives (seems like education and training is a separate step/initiative)
  • Kind of interesting to note the focus on distributing/consistent flow of knowledge but only within upper level institutions where knowledge is primarily contained

Alicia’s Notes:

  • Medical knowledge has been increasing, but there is a growing gap between our learning capacity and medical knowledge
    • Knowledge concentrated in academic centers
  • It can take ~17 years for new policies to actually be implemented after release of evidence (translation from clinical research to policy changes)
  • Lack of access to specialty care HepC in New Mexico (NM) was what drove the ECHO movement
    • In 2004: 
      • <5% of people infected with HepC were being treated
      • No prisoners who were positive were being treated
      • No primary care physicians treating HCV (as of 2004)
      • Comparison of treatment for HepC to chemotherapy
  • Patient outcomes of HepC ECHO (Extension for Community Healthcare Outcomes) pilot
  • ECHO Goals
    • Develop capacity to safely + effectively treat HepC in all parts of New Mexico
    • Develop a model to treat complex diseases in under-resourced areas (rural locations + developing countries)
    • Knowledge flows between academic/knowledge providers (hubs) and medical providers (spokes)
  • Incidence of Cervical Cancer Globally
  • Cervical cancer care and treatment in Mozambique (which Varon generalizes to capture “all” of Africa, typical of public health professionals when discussing data collection)
    • <5% of women receive cervical cancer screening
    • Higher rates of HIV (12% nationally; >20% in a number of urban areas), related to rates of cervical cancer 
    • Referral system not well established
  • ECHO-Cervical Cancer Prevention in Mozambique
    • From 2019-2020: 13 ECHO sessions; 24 patient cases presented and discussed in multidisciplinary setting
  • Project ECHO serves as one arm of a larger prevention and care strategy
    • Provider capacity building
    • Project ECHO
    • Patient level interventions
  • Plans to initiate Project ECHO in Latin America

Els’s notes:

ECHO model adds nuance to process of medical knowledge production: if we assume that knowledge is produced rapidly, doubling every couple of hours, like a finished product leaving the factory, it only becomes a matter of ‘feeding’ the medical provider with all of the knowledge (which is one of the ways we run into the limits of knowledge transmission). By creating a structure of hubs and spokes, the flow and continuous production and refinement of medical knowledge becomes explicit: knowledge is, in this kind of setting, not a static product, but rather something that emerges through collaborative effort and mutual teaching and mentorship.

Underserved rural areas: what knowledge can flow from medical providers in underserved communities to the knowledge hubs of academic medical centers?

ECHO as part of larger strategy: again shows that flow and production of knowledge is not linear, but rather a matter of creating multiple, complex networks (in this case, networks of care), that bring together clinicians, academics, government institutions, local health initiatives, and patients, families, and local communities.

 

LITTLE TECHNOLOGIES

Jose Gomez-Marquez leads the “Little Devices Lab” at MIT and will be discussing “transparent technologies” in global health. In particular, using the idea of “transparency” as assuming some kind of “intuitive” understanding of how a technology worked–that once someone could gaze upon an object, they would know how it worked. “Transparency” is without any black boxes–the creators of who Gomez-Marquez calls “maker-nurses.”  Are there “maker-nurses” in America? Gomez-Marquez asks. And what place do they have in the discourses of “innovation” in a healthcare landscape of big technologies? Do they “work”? Some of these include tests for dengue fever, corono-virus, and cancer (not sure what kind), among others. Rather than scaling up these technologies, Gomez-Marquez instead prefers to distribute these methods as protocols that will allow for more improvisation. 

Jose Gomez-Marquez and Anna Young, “A History of Nurse Making and Stealth Innovation,” SSRN Scholarly Paper (Rochester, NY: Social Science Research ilaiNetwork, May 11, 2016), https://doi.org/10.2139/ssrn.2778663.

Alicia and Alex’s Notes

  • Current medical technology development practice divided in 3 areas: 
    • Generate construction kits to lower prototyping costs
    • Develop bioengineering solutions to diagnose disease
  • “Transparent technologies” in global health 
    • Gomez-Marquez compares current medical technology to a “series of black boxes”
    • Transparent technologies need to be understood like the average person understands bikes
    • Example: first pregnancy test created by a graphic designer (motivated by the idea of letting women do this at home)
  • “Maker-nurses” in America
    • Healthcare workers who are designing and implementing technologies to address issues identified among their patients
    • Gomez-Marquez compares modern research in nursing to public health 
  • Development of the maker-nurse program at MIT
    • Anyone (regardless of their background) could walk in to build a technology that they believe would help their patient; and then they could walk back out
    • Gomez-Marquez argues that such a system is more efficient than any sort of “formal” collaborative research effort at MIT
  • Perhaps this maker-nurse program structure could help address the time-lag in researchers’ development and delivery of diagnostic devices
    • Zika, Ebola, COVID-19
    • Things that were being made in the lab were not reaching the patients in time. Gomez-Marquez is asking, “how can we reform this?”
  • Design for hack
    • “User-enabled medical prototyping”
    • Ideation/innovation funnel vs Design trajectories
    • End-game products can fail, but we can redesign and reimagine technologies
    • Ampli (“construction sets for paperfluidics and diagnostics”) — kits with lego-like parts that designers can remix and develop a new device
    • Making cheaper and more accessible technologies using parts we already have
  • FairTradeBio

“Stealth innovation” has decreased, says Gomez-Marquez. 

Els’s notes:

What is the role of failure in the work of the “Little Devices Lab”? If the lab can export their protocols, how does this challenge knowledge cultures in medicine? That is, much of academic and medical culture is more and more wary of failure—think for example of the white coat syndrome that is not only prevalent among patients anxious about their interactions with doctors, but also in hospitals and medical settings, where it can be near-impossible to challenge doctors or point out their mistakes. If we open up medical institutions to encourage ‘thinkering’ through these kinds of maker projects, how can this open up medicine more generally to encourage cultures of discovery and innovation, with its inherent connection to failure.

Engineering Pedagogy

Andi Gobin, PhD is the NEST (Newborn Essential Solutions & Technologies) director at Rice 360 to help strengthen the engineering curriculum. In particular, Gobin is interested in “global health” and “global education” as a way of building infrastructure. Gobin begins by examining ways to address infant mortality in (South Africa?) 75% of which can be preventable. What is at stake if environments (electricity grids, weather patterns) are unstable and unpredictable? Is there room for improvisation after “education”? The infrastructure of education–yet what are some of the ethics involved in this kind of paternalistic “dissemination” of information? Are these discourses perpetuating “Third World” narratives? 

Alicia and Alex’s Notes

  • Gobin prefaces her presentation with the following idea: whenever you start talking about global health/global education, more than just this notion of “donating” or “aid” — we got to think about infrastructure development that builds community
    • Education is key
    • Financial donations to countries in Africa are not sustainable 
  • 75% of newborn deaths in sub-Saharan Africa are preventable 
  • NEST’s model and track record:
    • 4 parts of NEST’s approach: innovation, education (and human resource), market shaping, and implementation learning 
      • Addresses gaps in these regards (technology gaps, human resources gaps, implementation and investment gaps, and market gaps; often context specific 
      • Interdisciplinary education and building community (referring to onsite doctors, nurses, technicians, etc)–teaching more than medical professionals, but students, engineers, etc. to be able to teach the public 
      • Communication gap between clinicians and technicians  
      • “Equipment graveyard”: most of the technologies donated from other countries to those in Africa are surplus/leftover/nonfunctioning technologies; the issue with these is that the power outlets required for these devices do not match those available in African countries; they also do not store well given the differing climates between the technology’s country of origin and countries in Africa
        • I lowkey remember this from GLHT 
        • Every hospital in Malawi (?) + Nigeria (?) has these equipment graveyards
        • Reuse these technologies for parts to create more accessible/friendly tech (“design studios” initiatives in these countries)
        • Polytechnic design studios:
          • Gobin notes that students + faculty in African countries are used to learning from a textbook as opposed to a more real-world/application-based approach
          • Students used to working individually rather than in teams 
          • Ex. DIT Design Studio in Dar es Salaam Institute of Technology
          • Internships, national + international design competitions available to students
    • 16 million babies born in facilities with NEST
    • Newborn mortality reduced by 50%
  • Gobin is Director of NEST 360 Invention Education 
    • Oversees collaboration between students and faculty in academic institutions across the US, Malawi, and Nigeria 
    • Goal of the Invention Education arm of NEST 360: dissemination of information; increase access to that knowledge (common thread across all 3 talks) 

Q&A

What do you do about regulation? Depends on the technology. Sometimes regulations are defensive measures. 

Attention paid to the ethical implications of providing such solutions and innovations (Gomez-Marquez)

  • Building local infrastructure + capacity 
  • “We are not the heroes, we are just there to facilitate, bring the education, …” (Gobin)
  • “Trust needs to be built on both ends, because there’s such a history of exploitation…” (Varon)
    • Shares how the members of the community she and her team worked with in Mozambique were distrustful and did not think people would stay 

 

Health Policy and Ethics 

Location: Onstead Auditorium, MD Anderson 

Speakers: 

Meredith Walsh, MPH, NP-C b”

Jeffrey Ashley, DrPh, MS.Ed, MS 

Janet Kasper, LBSW 

Moderated by Sheryl McCurdy, PhD 

2:10-3:05

 

Healthcare Reimagined Through Virtual Reality 

Location: Research Institute Boardroom, Houston Methodist Hospital 

Speakers: 

Eric Liga Houston VR, chief NedEd VR, introduces VR technologies that reconstruct environments in medical pedagogy and health care application. 

Katherine and Brenda’s Notes: 

Pain/Anxiety Management:

  • Medical VR treatment usage: pain and anxiety management (VR environment to take burn patients out of their environment when their wounds are being cleaned— significant paint reduction, to the point of a low dose of morphine)
  • Packard’s Children’s Childhood Anxiety Reduction : snow world! Puts children in cold environment, with snow men etc.

“Giving them something to focus on… report less pain and anxiety”

  • pain management during Childbirth
  • drug rehabilitation — lets patients (voluntary admit) who wants to leave/out of their situation float down river (Eden River HD)—calming environment with birds flying around them (sounds like a true Disney scenario!)

“Disrupts them in a positive way… Displacement between body and their mind.”

PTSD treatment:

  • Project Brave Heart VR: prepares patients for open heart surgery procedure (??), managing stress response through what is essentially mild exposure therapy (pretty common anxiety management technique—asks you to imagine yourself walking through the experience, but in this case it’s assisted with VR)

“here’s where you’re going to check in, here’s what your procedure is going to be like… Inoculates them against anxiety on the day of.”

  • VR in PTSD treatment (US Army, Landstuhl Regional)—recreate the mission that they went on. They relive it over and over until they have a less intense response.

Phobia Treatment:

  • See the spider on their hand
  • Fear of heights— VR great for conveying depth and scale

Medical Procedure Training:

  • Surgical training through VR: virtual surgery (Osso VR) teaches surgeons which tools to use, how to use them—training muscle memory. Hand-held tool can give feedback when you use a drill or tap a hammer. Gives you a sense of how much to turn hand.
  • Reminds me of the challenges of learning anatomy from medical atlases (see Daston and Galison, “The Image of Objectivity”) which are either highly stylized to show all organs etc, or highly realistic, which means the relevant organs are hard to distinguish, not to mention that everybody is different, blood and other fluids might block your view, etc. How does VR training anticipate this, and allow surgeons to practice surgeries in a more realistic way?

Strabismus Correction:

  • Vivid Vision — brighten for non-dominant eye, dim for dominant eye. Highly Effective!

Physical therapy:

  • neuro rehab VR (Fort Worth Neurological Recovery Center), showing legs working properly during PT, which helps rebuild pathways after neurological event. VR PT also helps track patient compliance (does it make it more motivating too? Like how biking on a Peleton is apparently more fun, because you can put the Tour the France route on your screen?)

Anatomy Training:

Classroom learning: Frog Dissection

Demonstration to look at specific portions of a heart

Brenda Quintanilla, PhD- HCC Center for Learning and Innovation 

 

Building a Brand that Stands Out in the Global Health Space 

Location: Onstead Auditorium, MD Anderson 

Speakers: Valentina Gomez Bravo- Bunker +58 

Valentina Gomez Bravo, the Founder, CEO & Creative Director of Bunker +58 discusses the importance of branding in the digital age and notes that we must take advantage of the space in which global communities mainly engage.

Alex’s Notes

  • We have preferences of certain brands because of what they stand for and what we affiliate/associate them with.
    • There are physical representations of brands in human form.
  • Branding consists of Visibility, Credibility, and Profitability (know, like, trust)
  • Being a student is the perfect time to build your brand! (She called me out for coming in late by using me as an example hahahahaha)!!!
    • LinkedIn !!
  • 6 steps
  1. Decide to start
  2. Evaluate where you are now vs. where you want to be
  3. Streamline your message on how to best sell YOU
  4. Identify who you want to serve
  5. Get all of your brand visuals consistent
  • Brands utilized for representatives of “global health” mainly focus on dermatology/health/lifestyle. Lots of plastic surgeons, nutritionists, pediatricians; some psychiatry and some optometry. 
    • Dr. Pimple Popper, Dr. Mikhail Varshavski
  • “A business without a brand is like a person without a soul.”
  • The platforms we utilize depend on the audience we are trying to reach and our comfort with the platform.

My takeaway: I need a business card.

One of the questions here is that some things are easier to brand than others. “Empowerment” and “innovation” are ideas that are easy to brand, and we can turn a similar gaze onto less exciting ideas, like “infrastructure” and “protocol.”  

→ She says, regardless of your cause, social media will help give you a platform to broadcast it

 

Designing a Sustainable Health Program 

Location: Small Classrooms, MD Anderson 

Speaker: Chris Wong- Baylor College of Medicine 

3:15-4:45

Global Surgery 

Location: Research Institute Boardroom, Houston Methodist Hospital 

Speakers: Jed Nuchtern, MD Kjersti Aagaard, MD, PhD, FACOG Youmna Sheriff, MD Matthew Basilico, MD 

Moderated by Rachel Davis, MD 

Research Institute, Houston Methodist Hospital 

Jake and Katherine’s Notes

Youmna Sherif, MD

Global surgery education and ethics as they relate to medical training

  • Surgically treatable diseases account for 11% of total burden of disease
  • cost-effective approach to improving disability adjusted life years
  • Train in resource limited settings
    • Ultrasound is the most reliable imaging technique in resource-limited areas

Based on 4 primaries:

  • Clinical knowledge (ultrasound, anesthesia, etc.)
  • Surgical Infrastructure and capacity building
  • Academic Inquiry
  • Advocacy and Collaborate (build meaningful relationships with patients)

What does my presence in a resource-limited setting mean?

Ethics:

  • Limitations in surgical capacity and infrastructure
  • Outcomes monitoring
  • Individual vs the system (how many people do we treat while abroad? Were there complications?)
  • Cultural competence and language barriers
  • Familiarity with surgical procedures
  • Incongruent expectations
  • Absence of ethics structures
  • Financing global surgery (how much do the patients see? How many can we treat?)

Trainees and global surgery considerations:

  • If I take new gloves every time I treat someone, am I taking it away from someone?
  • Issue of consent
  • Is it interfering with their training?
  • What can your grants be optimally be used for?

Guiding principles for trainees

  • Research about the area, culture, etc.
  • Clarify expectations
  • Petform pre-departure training
  • Respect institutional priorities
  • Finance ethically

Guiding principles for the training academic institution

  • Careful site selection — meaningful collaborations
  • Workforce retention

“Above All-Do No Harm”

“Our goal is to be not just surgeons, but advocates”

“Create something bigger than ourselves”

Kjesti Aagaard, MD PhD MSCI (Henry and susan E. Meyer Endowed Chair)

  • Goal: give more than you take
  • Why is there such a great burden maternal morbidity and mortality globally? 
    • Historically, women’s and maternal health research is horrifically underfunded. Solution: Global partnerships.
  • Each part of the world has a slightly different problem, and cause to that problem
  • More maternal mortality/near-death experiences in outlying hospitals rather than central hospital
    • Large proportion of population lives outside of urban areas
    • No ambulance transport system, most transportation is by oxcart/bicycle
  • Solution – bring resources to people rather than people to resources 
    • Mentions Dr. Jeffrey Wilkinson – fistula expert, works almost entirely in Malawi
    • “Why? Because fistula isn’t a problem in the US. That’s his passion, bring resources to people rather than people to resources”
  • Emphasizes the importance of aesthetic architecture of medical buildings, even in under-resourced areas
    • Permiculture garden around maternity waiting home
    • Nutrition/cooking classes
    • Make the facility a place where people want to work and give birth
  • 0 maternal deaths at their facility (compared to nat’l avg of 1/39)

Questions

  • Dr. Nuchtern – Dramatic shortage of anesthesiologists/OBGYNs in Sub-Saharan Africa
    • In South America it’s not a shortage, but a distribution problem
  • Dr. Aagaard – “If you’re not card-carrying and licensed to do something in the US, you shouldn’t be doing it abroad.” Indirect critique of voluntourism + the (excessive) freedom some of these programs give to students w/o any medical experience or licensure

 

Psychosocial Issues 

Location: Onstead Auditorium, MD Anderson 

Speakers: Sophia Banu, MD; Jacquelyn Alutto McClain Sampson, PhD, MSSW; McClain Sampson, PhD, MSSW; 

Moderated by Christine Markham, PhD 

Sophia Banu, MD is an associate professor at the Baylor College of Medicine. She is presenting a talk titled “Clinic for International Trauma Survivors, Working with Refugees and Asylum Seekers in Houston.”  

Alex’s Notes

  • Types of displaced populations: Immigrant vs. refugee vs. asylum seeker
    • Large numbers of displaced peoples
    • Very long and difficult process for resettlement in the U.S.
    • Common misconceptions in the U.S. can be challenges for refugees to overcome
    • Can be especially difficult for children who migrate; 1 of every 2 refugees are children
  • Case studies
    • Traumatic experiences from journeying and status as a refugee can be difficult for children especially to cope with
    • Understanding the experiences (especially, pre-, trans-, and post-migration) of refugees allow us to provide better treatment plans for children
    • It is also important to view children’s experiences in terms of their life histories because there is evidence that cumulative traumatic experiences may be more salient to the development of psychopathology than pre-migration experiences.
  • Recognizing the above and treating patients with this knowledge allows for growth. Post-traumatic growth can occur in 5 domains.
  • Wish she wasn’t pressed for time 🙁 I like her topic

Annie’s Notes

  • 1 in every 108 people on earth is an asylum seeker or refugee 
  • US resettled over 3 million refugees since 1975 
  • Less than 1% of the 25.8 million refugees have been resettled- very stringent criteria, ex. Torture survivor, urgent need of medical attention 
  • 1 of every 2 refugees are children 
  • Case study, 16 y/o refugee boy from Bhutan
    • Born in refugee camp, 14 when came to U.S.
    • Farmer parents, couldn’t speak english but he had gone to school at the camp and spoke a little english and this had to become a proxy for his parents 
    • Depression and stress from all his responsibilities
    • His wish was to turn 18 and go back to the refugee camp 

McClain Sampson, PhD, MSSW is an associate professor at the Graduate College of Social Work at the University of Houston. Her research focuses on maternal health, working most recently over postpartum depression of low-income workers. She is presenting a talk titled “Social Workers in Integrated Healthcare: Focus on health issues affecting mothers.” 

Alex’s Notes

  • Houston is one of the diverse cities in America with a large immigrant population which demands a diverse behavioral health workforce. 
  • One solution: collaborative care. For example, primary care integrated with behavioral health services. 
    • Solution for high-cost, high-care patients
    • HRSA grants aim to provide training for this
    • GLOBE team training
    • Creating an interdisciplinary approach to health care
  • Disparities in maternal health
    • ⅕ of women experience minor to major depression after childbirth; rates of depression and anxiety are much higher among low-income women due to chronic stressors
    • Global rates of PPD as reported are ill representations of the whole
    • Really strong focus on racial inequalities and disparities 
  • Utilizes quantitative and qualitative methods to explore disparities in maternal health
    • Interviews, pre-existing datasets
    • Utilizing sociological/psychological concepts of implicit and explicit biases, economic disparities, race relations

Annie’s Notes

  • Necessity of mental health as part of access to quality healthcare 
    • Shortage of clinicians that are specially suited for culturally diverse patient populations- esp. important for Houston 
    • Need for collaborative care, ex. primary care with social work
  • DIsparities in maternal health intimately related to stress- low-income, stigma, cultural attitudes about motherhood 
  • U.S. had the highest maternal mortality rate of any industrialized country- relatively new “mainstream” discovery 
  • 2018 Houston Endowment Improving Maternal Health Steering Committee Report  
    • Mother vs. fetal health 
    • Maternal and fetal health are indicators of health 
  • UH Healthy Start
    • Home visits and community education in homes- campus presents a barrier 
    • Social workers are essential: 
      • Person-centered approach, emphasize that mothers are in control of their own lives and are able to take proper care of their children 

Jacquelyn Alutto; founder of Real Beauty Real Women, Director of Break The Cycle USA, and Harris County Precinct 1 Human Trafficking Liason/Advocate; is a producer and documentarian merging entertainment, beauty, and technology world to break the cycle of human trafficking. She is presenting a talk titled, “Combating Human Trafficking.”

Alex’s Notes

  • Engaging celebrities in discussion of human trafficking
  • Texas is #1 in Human Trafficking
  • Alutto’s presentation comes from experiences and on-the-field work, rather than technical or formalized education
    • Gives her a unique perspective and understanding of the people she works with and seeks to represent
    • Documentaries and interviews as case studies

Annie’s Notes

  • Present instead of post traumatic stress
    • Proper trauma informed care for survivors is essential- they will not ask for this directly, trust takes time 
  • Trauma bonding- if you were abused or abandoned growing up you associate that with love, manipulation and gaslighting 

 

4:25-4:30

Opening Remarks 

Location: Onstead Auditorium, MD Anderson 

“Extending Our Reach to End Cancer” 

Jeffrey E. Lee, MD- Vice President, Department of Medical & Academic Affairs, Cancer Network, MD Anderson Cancer Center Patricia Brock. MD – Board President of Houston 

In the opening remarks, Jeffrey E. Lee discusses his work as the chair of surgical oncology at MD Anderson. Lee begins his address with a map of MD Anderson’s reach–which also seems to be a political map since there are no bases in Russia (among other countries). Some of the treatments that he mentions include screening initiatives, policy suggestions (for prevention and screening), vaccine trials, and collaborative clinical trials (such as pilot programs in Brazil). In describing each of these initiatives, Lee did not mention “ending” cancer. Though he does mention the timeliness of the global health conference amid a global health crisis.

4:30-5:30 

Global Health Collaborative 

Location: Onstead Auditorium, MD Anderson 

“Achieving Global Health: The Race to Develop Vaccines for Emerging and Neglected Tropical Diseases”

Keynote Speaker: Maria E. Bottazzi, Co-Director at Texas Children’s Hospital Center for Vaccine Development At Baylor College of Medicine 

In her keynote, Maria E. Bottazz discusses the importance of vaccine research. Bottazz begins her talk with the 1978 Alma-Ata WHO meeting (in Kazakhstan!), which is also a really interesting historical moment because physicians from Sri Lanka also attended–in addition to physicians in China–in the thick of the Cold War. Bottazzi later focuses on the social history of NTD (Neglected Tropical Diseases). 

Annie & Jake & Katherine’s Notes:

Why global health (and vaccine) research can “transform the world”

Spearheading global health technologies

  • 1990 – Global Burden of Disease project was commissioned to quantify health effects of >100 diseases – morbidity + mortality metrics 
  • 2000- UN launched their Millennium Development goals 

21st century framework for global health

  • “It’s a race. Everyone wants to show that they can meet and hopefully target the global targets.” — sounds like every country wants to demonstrate their prowess in their capacity to help others. Interesting that something that is supposed to be selfless has ulterior motives. Everything is a competition between countries, even within a global health conference. Disease doesn’t discriminate between nations.
  • Expanded number of goals that are much broader and include topics such as climate 
  • Goal 4 and 6: reducing child mortality and expanding use of vaccines 
  • Expanded use of vaccines, and development of new vaccines
    • Large reductions in measles/TDaP/Hib/pneumo/rotavirus deaths
  • NTD’s weren’t a sexy topic until a group of scientists spent 10 years marketing them
  • “Other diseases” are highly prevalent and emerging that mainly affect the world’s poorest people. It seems like those who can pay for the treatment spur on the speed of treatment and determine access

Tropical Disease/infection 

    • Very broad category, any disease could potentially be categorized as a tropical disease 
  • Neurocysticercosis: https://www.ncbi.nlm.nih.gov/pubmed/15847365=
        • Lots of research based out of Peru; Bottazzi apparently wrote a paper about this: 
  • Peter J. Hotez et al., “The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and Elimination,” PLoS Neglected Tropical Diseases 2, no. 9 (September 24, 2008): e300, https://doi.org/10.1371/journal.pntd.0000300.
    • Anthropocene forces are underlying factors for all of these diseases—how human influences change the environment (usually linked to climate change like in this article “Learning How to Die in the Anthropocene” by Roy Scranton) 
      • For a review on the anthropocene from anthropologists: 
  • Hannah Gibson and Sita Venkateswar, “Anthropological Engagement with the Anthropocene: A Critical Review,” Environment and Society 6 (2015): 5–27. https://www-jstor-org.ezproxy.rice.edu/stable/26204948?seq=1
  • Bottazzi shows us a gif of a whack-a-mole game, to show that even though we each have a niche, we need to keep a global perspective. Constantly new diseases popping up and vaccines to treat them.

“Knowledge co-production” 

    • Translating biomedical science into products – ties back to point about PDP marketing
    • Requires interdisciplinary collaboration 
  • Bottazzi mentions challenges in crossing “valleys of death” which involves social and economic challenges. Also, working with people is hard. 
    • Valley of death #1: Bench to clinic
      • Translation – Clinical trials, R+D
      • Sars/Mers Vaccine initiative is currently in the preclinical phase (valley #1) — will we see expedited progress with this given COVID-19?
      • Valley of death #2: How to bring product to the people after you show safety and efficacy (harder than valley #1). Reproduce studies in different countries. 
      • We don’t have the money to fund treatment for often neglected infectious diseases
        • Implementation – distribution in communities, financing, WHO policy
        • Bottazzi mentions the increasing de-funding of NTD’s. 
  • Eva M Riedmann, “Human Vaccines & Immunotherapeutics,” Human Vaccines & Immunotherapeutics 9, no. 8 (August 1, 2013): 1611–14, https://doi.org/10.4161/hv.26189.
  • “Human Vaccines & Immunotherapeutics: News,” Human Vaccines & Immunotherapeutics 12, no. 9 (September 12, 2016): 2216–18, https://doi.org/10.1080/21645515.2016.1226103.

The changing landscape of vaccine development:

Addressing diseases that disproportionately affect the world’s poorest people

  • Shift in focus since 2015:
    • Vaccines for future pandemic threats
    • Vaccines for conditions w/ high mortality in kids <5
    • Products w/ lower risk, greater effects 

Coronovirus vaccine 🦠 SARS CoV-2

  • Coronavirus isn’t the 1st outbreak—it’s the 3rd. First two were SARS and MERS 
    • Less lethal than SARS (10% vs 2%)
      • Coronavirus RNA virus closely related to other infectious disease (80%-90% to SARS, 75-80% to S protein, 50% to MERS CoV)
    • Highest risk: >60 years old, male
    • Target of vaccine: SARS-CoV receptor binding domain—block/neutralize the binding and entry of virus into lung cells. This will reduce infection, disease, and transmission.
    • 2016-2020 Pause (no funding bc no interest in curing SARS or MERS)
  • On CoV-2 receptors: Renhong Yan et al., “Structural Basis for the Recognition of the SARS-CoV-2 by Full-Length Human ACE2,” Science, March 4, 2020, https://doi.org/10.1126/science.abb2762.
    • There are so many similarities in terms of the virus composition 
    • There is enough for maybe around 20k human vaccines (but access to who?) 
    • Pathology. Disease transmutation –> You don’t want the vaccine to introduce symptoms worse than what they already have.

Bottazzi emphasizes the need to learn how to handle media and engage with the public, because scientists are not taught how to be in front of the media. “It’s nerve-wracking, and they always interpret what you say.” How do we communicate to non-science laypeople/non-experts (more humanities training!) 

…no questions?

 

Saturday March 7, 2020  

8:30-8:50

Opening Remarks 

Location: Onstead Auditorium, MD Anderson 

Stephen J. Spann, MD, MBA – Founding Dean of University of Houston College of Medicine 

8:50-9:45 

Keynote Speaker 

Location: Onstead Auditorium, MD Anderson 

Theresa J. Ochoa, MD- Director of the Institute of Tropical Medicine Alexander von Humboldt 

10:00-10:55

Neglected Tropical Diseases 

Location: Research Institute, Houston Methodist Hospital 

Speakers: Eric L. Brown, PhD 

Jill Weatherhead, MD, MS 

Kristy 0. Murray, DVM, PhD 

Moderated by Andrew DiNardo, MD 

 

Global Oncology 

Location: Onstead Auditorium, MD Anderson 

Joseph Lubega, MD, MPH, CPE 

Chidinma Pamela Anakwenze, MD, MPH

Mark Zafereo, MD 

Moderated by Syed Nabeel Zafar, MD

Samantha and Alicia’s Notes:

  • 17 million new cases per year and rising
  • Cancer: #1 cause of death in HIC, #2 overall 
    • Incidence rising most rapidly in low income populations (LMIC)
    • Globally, 1 in 6 deaths caused by cancer
  • Multidisciplinary:

Joseph Lubega: pediatric hematology oncology

  • Formula for sustainable access to PHO care in low/middle income countries: partnership (government, community, private sector), foundation (building on platform of HIV/infectious diseases), capacity building
  • Not infectious vs noninfectious diseases – interconnected support
  • PHO means pediatric excellence against diseases
  • Pediatric non-communicable diseases are major cause of <5 mortality 
    • None of the UNICEF results report sickle cell disease as a cause of under-5 mortality
      • Reason is because many of the children die undiagnosed, or the cause of death is attributed to pneumonia or something else 
          • 30,000 new cases of cancer per year (<10% survival)
          • 100,000 born with sickle cell disease (~80% die as infants)
          • Lack of access to surgery and critical care  (lack of intervention)
  • Challenges of accessibility in sub-Saharan Africa
    • 15,000 children in US develop cancer each year, and 80% survive
    • 100,000+ children in SSA develop cancer each year, and 90% die (thankful that Dr. Lubeg acknowledged that Africa is not a country and a continent of countries)
    • Great improvements to outcomes of children with cancer after Texas Children’s Global HOPE program in 2016 
      • Most pass “benchmark” of 1 month survival after diagnosis
    • Improving the quality of life of children with cancer (not just cure them)
      • Lodging, activities, Kids’ Club 
      • Community engagement, mobilization: Educate kids and parents about treatment and make sure that they follow it 
  • Increased capacity to provide care to children with cancer + blood diseases 
    • Fellowship training program for doctors (PHO Fellowship in East Africa) — formal pediatric oncologist training is not common in East Africa; children with cancer are often seen in random, dispersed pediatric wards
    • Global HOPE shifted paradigm of sub-specialty training 
  • Spectrum of cancers: Leukemia, Brain tumor, lymphoma
    • These numbers do not necessarily reflect how many cases exist – dependent of access to care (there may be many more cases that are not reported)
    • Especially in the case of children with brain tumors, there needs to be collaboration between pediatric oncologists, neurosurgeons, and neurologists
  • Benefits of formal training on-site (training people in situ):
    • Train lots of other people informally along the way
      • Impact lots more people
    • multi-disciplinary/specialty workforce
  • Engagement with government and community
    • Understand local context – most pressing issues
    • Assume people don’t know the context – educate
    • Addressing key local issues
      • Socioeconomic barriers 
      • Use, strengthen, sustain foundation of HIV/Infectious diseases
      • Create structure for pediatric care in different settings

Chidinma Pamela Anakwenze: global radiation oncology

https://www.bbc.com/news/health-26014693

      • Predicted global cancer cases – increasing in lower income countries
        • Causes: Patients live longer
        • Poor screening, economic limitations -> advanced diseases that often require radiation (limited access) 

Number of People Served by One Radiotherapy Unit

  • Radiation: local therapy 
        • Brachytherapy – internal radiation
        • Teletherapy – external beam radiation (xrays or ionizing radiation targets cancer cells)
        • Worldwide shortage of therapy in low income countries 
          • Standard: 1 machine per 250000 people 
            • Some countries have no machines available, others is 1 machine per 5 million people 
    • Nigeria: biggest deficit in radiotherapy availability 
      • 1 machine/25.6 million people, even though the standard is 1 machine/250,000 people (in the US, there is 1 machine/87,000 people)
      • No “one size fits all” for global health 
        • Equality – donate equipment, but they sit in disrepair because countries don’t have resources (economic, education) to maintain the machines
        • People of different body types, diseases, age, race, etc. all use the same machine – not individualized
        • Equity-driven approach (rather than an equality-driven approach) – lack of funding to maintain equipment
          • Focus on unique needs of country and give them something that suits their needs 
      • Unique needs of Nigeria to improve radiation access:
        • 8 radiation centers in 2016; of those only 1 or 2 machines were functioning at a given time (there was, however, a private center with machines functioning most of the time)
        • Insufficient federal funding to keep constant power
        • Private center usually runs (to generate revenue for investing companies)
        • Dr. Anakwenze worked specifically in University College Hospital in Ibadan, Oyo State (SW Nigeria)
        • Identify social, cultural, political, financial barriers to accessing care
          • Key informant interviews to assess delivery of radiotherapy (n=28 doctors)
          • Patient questionnaires
          • A single machine (Cobalt-60) was treating 30-90 patients per day; according to IAEA, though, each machine should be treating a max of 60 patients each day
          • Rapid breakdown of devices due to overuse 
          • Lack of staff: even though there was a surplus of engineers at this hospital, they were inadequately trained 
          • Common themes of reduced access (insufficient federal funding was the central theme of all of these common themes):
            • Lack of equipment
            • Staff-related issues, workers going on strike
            • Environmental related issues — power failures; poor governmental energy use
            • Having few centers in area: on average, patients are over 100 miles from nearest hospital 
            • Policy issues – no funding 
            • Patients can’t afford care (borrow from church, community, etc), long travel
              • Most of the patients seeking care were more educated than the average population
  • Insufficient federal funding (poor governance)
            • Patients waited 12 months after diagnosis before radiation care; compared to 2.5 months in UK (with nationalized healthcare system) 
            • Distance from home to UCH + unemployment status were main barriers patients faced 
            • Patients wait all day just to get treatment (sometimes they didnt have time to get treatment at all – lack of time, breakdown of machines, power failure)
            • Delay in treatment = worse outcomes 
            • Lack of health insurance
        • Policies regulating donations of equipment
          • IAEA’s donation of equipment each year is no longer a sustainable policy (especially when local engineers are poorly trained)
          • In 2016 UCH was exploring purchasing a brachytherapy device through private public partnership 
            • Private company (financial interest) 
            • Higher quality and more consistent service, but prohibitively increased cost for patients (x2-4 more expensive)
    • Anakwenze conducted a 2020 report updating radiation therapy in Nigeria 
      • Federal machines were broken down for 35% of the year last year
      • Increase in equipment (8 machines in 2020, up from 1-2 machines in 2020 — unsure if these are all the machines available in all of Nigeria)
    • 800 machines, though, according to IAEA would be needed in Nigeria
  • Is private-public partnership the way to continue improving access?

Mark Zafereo: head and neck surgery/beyond patient care

  • Most useful metrics for sustainable medical outreach:
    • Number of physicians trained
    • Quality of training
    • Collaborative meetings, research, and guidelines
    • Donations of medical equipment and scholarships (private companies)
  • Historically subspecialization in African countries is very rare (Lubega specifically mentioned pediatric oncology subspeciality training is uncommon; Zaferero talks specifically about head and neck surgery subspecialization)
    • Difficult for surgeon to do everything well – need greater subspecialization 
    • Visiting different education environments can stimulate their passion, learn new techniques – improve treatment 
  • Gold standard treatment: 
    • $10,000/year grant – trained 1 fellow per year 
      • Does not require as much money as we think – donations can be extremely useful
      • He’s trained a number of fellows, so that they could 
    • Trained fellows go back to their own countries to head new departments and develop efficient training programs of their own 
    • Workshops: country-wide/continent-wide meetings
      • Bring residents, colleagues to workshop and stimulate their education
      • Held mostly in East Africa 
      • ~1 week 
        • Can’t be too long or they disrupt normal hospital flow (budget, staffing)
          • functioning on shoestring budgets; staff are overworked; doing a course like this puts a lot of strain on the local system
        • 60 surgeries, set up curriculum for week, lectures
          • Didactics, cadaver dissections, OR cases (<10 cases; allows optimal training without overwhelming resources)
          • <10 cases (proctored): optimal training without overwhelming resources [designed for local physicians and residents for optimal OR experience] — US trainees are taught to not expect as high of a volume of training as would be expected in North America
          • Use local equipments because there is no point bringing equipment briefly then take them away 
          • Scholarships from MD Anderson provide grants for students in Africa
    • Metric: how many medical students and faculty are trained in the courses (over 1,000 medical students, residents, and faculty trained at Academic Institutions in East Africa)
      • Patient care
      • Education: resident exchanges
  • Treatment paradigms for head and neck cancer differ in high- vs low-resource settings (Ferereo doesn’t really go into what differences exist, though)
  • Evolution of global outreach:
    • Surgery: from volume of patient care to quality of education and capacity-building (long-term growth)
    • Collaboration and quality improvement evaluations 

Q&A Session:

  1. How did Lubega  start and develop your passion into where it is now? 
  • Trained in Uganda, and then moved to US
  • During fellowship interview at TCH, interviewers asked: why does it take you 9 years to get all the necessary training?
  • Lubega had to do residency training twice; went back and forth between UK and US; no subspecialty training in Uganda + rest of Africa
  • According to Lubega, if you want to do global health, you need to be as broad as possible (he had to address both infectious diseases + critical care issues) 
    • Sometimes it’s less about the medicine, and more about understanding leadership, understanding governance + financial workflow, managing teams
  • Reason to do global health: expanding importance and emphasis (employment)

11:05-12:00

 

Emerging Threats 

Location: Research Institute, Houston Methodist Hospital 

Speakers: Philip B. Bedient, PhD, PE 

Alexandra van den Berg, PhD, MPH 

Nahid Rianon, MD, DrPH, AGSF 

Moderated by Rohith Malya, MD 

Samantha and Alicia’s Notes:

Phillip B. Bedient: Flooding in Houston under Climate Threats 
  • Sea level rise, storm surge, wind effects, compound floods
  • 3-6 feet sea level rise – largest natural disaster in the US if it hits the ship channel

Galveston Bay Park Plan

  • Prevent flooding along coastal spine – federal project
  • No protection since Hurricane Ike (2008)

Texas Medical Center

  • Bayou rising – only flood warning years ago 
  • After Hurricane Allison: added culverts 
  • Major infrastructure improvements:
    • Parking protection, flood doors, communications, operations and training

  • Project Brays ($455 million)
    • Rainfall has increased from 13 to 18 inches, from 2015 to 2020
    • Part of Project was to widen the Bayo
    • During Harvey (30-45 in of rainfall), Texas Med Center didn’t actually flood even though there was a lot of rain of the streets (this “miracle” was likely brought about by the Project)
    • Lots of housing development behind reservoirs – high flooding areas 
    • Kraft Hall (Rice)
      • Built under new flood rules  (500 year flood plan)
      • Slab is 2 ft above ground 
      • Architecture/flood plans could be adapted to buildings in Med Center

Climate Change Issues

  • Storm surge is a big deal
  • New 100 yrs levels are = old 500 yr levels 
  • Smart drainage: fort bend 

Harvey was a wake-up call – billions of dollars pouring into state to make major improvements 

 

Sustainable food systems: Linking human health and planetary health

Alexandra van den Berg (alexandra.e.vandenberg@uth.tmc.edu)

  • May not have enough supply of healthy food for everyone on the planet 
  • Challenge: Current dominant food system does not support human health or planetary health 
    • Outcome: Increased mortality due to starvation and diet-related chronic disease
    • Solution: Creation of sustainable food system
  • What is a food system
    • 4 or 5 part cycle includes food production, processing, distribution of food, food waste
    • Influenced by environmental, political, economic, social/cultural systems
  • What is a sustainable food system? (according to Food and Agriculture Organization (FAO) of United Nations)
    • Low environmental impact
    • Respectful of biodiversity and ecosystems
    • Nutritionally adequate, safe, and healthy
    • Culturally acceptable and accessible 
  • Current food system in the US (aka U.S. Industrial Agriculture)
    • Since 1940s, 1950s (after WWII) — we’ve developed a food production system which is cheap, efficient:
      • Larger farms – commercial (move away from family-owned)
        • Cheaper food
        • Monoculture — you only grow a single type of crop on a piece of land (depletes soil, more susceptible to pests)
          • Vs rotation crop – switching crops across seasons
            • Recycles nutrients into the soil, “natural fertilizers” 
        • High reliance on pesticides, fertilizer, feedlots to raise animals 
      • Feedlot – high-density, dark environments where animals are raised 
        • US has second highest consumption of animal protein in the world
  • Low environmental impact?
    • Produces 20-30% GHG (global warming)
    • Pollutes water systems — nitrate (in our most commonly used fertilizer) is the largest polluter
    • Depletes topsoil (2.5 cm of the top layer of soil; contains most of the nutrients for growing crops) with our monoculture system of farming — it takes 250 years to replenish this topsoil; we’re depleting at much faster rates than we are replenishing 

Global map of soil degradation

  • Landgrabbing – rich countries buying huge plots of land from poorer countries for money and, eventually, to grow crops on 
  • Destroys rain forests: 56 acres/min/day
    • Loss of biodiversity – habitat loss and fragmentation 
  • Nutritionally adequate, safe, and healthy?
    • 2 bill overweight or obese adults
    • 40% Americans are obese
    • More people are dying from diet-related diseases than from tobacco smoking
    • Lots of processed food, meat, fat, sugar; not enough fiber, dairy, fruits, and vegetables 
  • Is our food system economically fair and affordable? Culturally acceptable/accessible?
    • 821 mil people are food insecure globally
    • US: 23.5 M people live in food deserts (communities with limited access to healthy foods); people living in these food deserts have poorer diets because they can’t access the foods
    • 34 mil Americans rely on SNAP benefits (food stamps)

Current industrial agricultural system is not sustainable

  • Need to produce 50% more food than we are currently producing

Potential solutions for all countries

EAT-Lancet Commission on Food, Planet, Health makes the following 5 recommendations:

  • Healthy diets: balanced animal protein 
    • People in US + Australia eat more animal protein compared to other countries in the world; recommendation that animal protein consumption get redistributed more evenly across the world 
  • Reorient agricultural priorities from producing high quantities to healthy food
  • More tech to intensify food production to increase high quality output
  • Governance of land and oceans
  • Halve food losses and waste
    • Americans have 40% more food waste than the average person in the world
  • Issues of implementing these recommendations 

National Solutions

    • Subsidize farmers for growing diverse food options 
  • Decrease subsidies for corn, wheat, and soybeans
  • Need more independent farmers 
    • Farmers are all retiring; and this is a limited number of younger farmers 
  • More sustainability in US dietary guidelines, but this met mixed input from the Food and Drug Administration 
    • Big law integrated within the food industry; it’s not in their financial interest to support sustainability in the food system
  • Examples of countries who have increased food sustainability
    • Cuba has placed bans on fossil fuel consumption 
  • Food industries are not the ones who will be promoting a shift towards food sustainability; push needs to come from food consumers 
    • van den Berg believes that this will need to be more a people-powered, grassroots movement (large-scale policy changes probably won’t happen yet)
  • GMOs and their impact on the efficiency of food production system
    • GMOs seem to be fine health wise
    • Potential ecological impacts (many countries don’t allow US to import GMO produce)
Nahid Rianon: Aging, Loss of Independence, & Caregiver Burden 
    • 10,000 people are turning 65 every day
    • One of the patients Rianon worked with: 
      • 70-year-old woman fell and broke her hip while she was trying to walk in the storm and rain; in a year, this woman was in a hospice 
    • Understand caregiver burden (particularly in immigrant community)
    • Global health: places priority on improving health and achieving equity in health for all people worldwide
      • US population consists of ~50 million immigrants
      • 15% of adults who are 60+ years are foreign-born, and they are aging in the US
      • Often do not have family with them
      • Need to know patient background to give best care
    • “Retooling for Aging America”
      • Develop infrastructure to deliver inclusive health care
        • Health beyond clinic – who takes patient to doctor, call insurance companies, help them perform daily activities, etc. 
      • Diverse and aging population 
      • Individual health influenced by culture, diet, beliefs, family systems, access of care, risk for disease in each community 
  • Dependency on adult children
    • Is there infrastructure to help patient AND caregivers (inclusive healthcare)
    • Training on diverse health beliefs, policy-makers, health care providers
  • Caregiver – person directly involved in patient care or affected by patient’s health 
    • Caregivers must deal with complex issues: having to cancel an appointment because patient cannot make it to the doctor’s that day
    • No professional training is available
    • Caregivers are often family members of patients
    • Caregiver becomes 2nd victim of disease
      • Physical, emotional, financial burden; life-changing 
      • Demands lead to health problems (stress, physical strain, behavioral/lifestyle changes) 
    • Rianon’s patients were often caregivers who had to take care of their parents or spouses
  • Caregiver burdens — despite these burdens, caregivers feel rewarded for being able to do something for their loved ones and often forget that they’re becoming sick themselves
    • Psychosocial, physical/biological, medical/health 
    • Lack of freedom from taking care of patient
    • Helplessness, abandoned, stress, anxiety, fatigue
    • Often do not notice that they themselves are becoming sick 
    • Informal care – lack of training, resources
  • Caregivers in immigrant community
    • Minority status + lower income may aggravate psychological distress among caregivers 
    • Financial stress – negative psychological effects
    • Often, caregiver is transitioning into his/her own geriatric stage of life (sandwich generation)
  • Demographic milestone: increasing relative elderly, decreasing relative young people

Young children and older people as a percentage of global population from 1950 to 2050

    • Much more burden for younger generation to take care of geriatric people 
  • Prevalence of dementia and alzheimer’s around the world
    • Greater population, more burden for low and middle income countries 
    • Diseases that make people dependent on caregivers
  • Hip fracture (consequence of osteoporosis)
    • High rates in Asia (50% of all hip fractures predicted to occur in Asia by 2050)
  • Take home message
    • Cultural values are important in medical decision making
    • Understand family/social structure and involve the patient in decision making
    • Appropriately train health care force
    • Think about the caregiver
    • One size does not fit all – individual care for patients and caregivers 

 

Sustainable Health Relief 

Location: Research Institute Boardroom, Houston Methodist Hospital 

Speakers: Clifford Dacso, MD 

Walter Ulrich 

Moderated by Beatrice Selwyn, DrPH 

Cliff Dacso, MD is professor of molecular and cellular biology at Baylor College of Medicine. He is presenting “Responding to the needs with a novel NGO” on behalf of his son, Matthew Dacso, MSc, the MDDirector of the Center for Global Health Education. 

Alex’s Notes

  • Making an NGO with a small amount of money to respond to an opportunity to address emerging infectious disease within the Dominican Republic
    • Lack of funds necessitates collaboration, especially with the community it serves
    • Identify local partners (local partner chosen because its need for diagnosing mosquito borne infectious disease)
    • Set up an NGO in the country and introduced a community wide institutional review board 
    • Collaboration between UTMB Health Center for Global & Community Health, Universidad Central del Este, Institute for Collaborative Health
  • Revamping previous spaces to create an investigation laboratory with new equipment and newly-trained researchers
    • How to promote ethical research in a place where it was previously unregulated

Walter Ulrich, the President and CEO of Medical Bridges, Inc., is presenting “The Good, The Bad, & The Global Need: Medical Equipment & Supplies.” In his talk, Ulrich underpins the importance of sustainability and ethics in the medical field, looking to eliminate wasteful operations by forwarding unused materials to countries in need.  

Alex’s Notes

  • Success of NGOs require collaboration with the community
  • There are many NGOs that are well intentioned but do more harm than good
    • “In service to humanity”
  • Wasteful operations in premier medical centers (including Houston’s very own!)
    • Repurpose unused materials
    • Take in donations from hospitals and organizations, including dialysis machines
    • Sending supplies from Texas ports
  • Medical Bridges is serving international medical centers where need is the greatest 
    • Sustainability
      • Providing good, non-expired supplies from surplus or discard “prepared and respectfully delivered”
    • Ethicality: 
      • Addressing disparities in countries by addressing gaps in technology
        • Some of these countries don’t have the basics!
        • “We take for granted what other people can’t even begin to have”
      • Medical Bridges abide by certain standards when sending out materials to abide by strong ethical beliefs and to affirm respect for countries they work with
      • Sustaining relationship with country and community
    • Can be very difficult to transport due to regulations, corruption, long-winded procedures
  • Support from Medical Bridges has also helped build medical facilities in international communities
    • Hospital built in Haiti

 

POSTERS 

12:00-1:25 

1:25-2:10 

Plenary Session 

Location: Onstead Auditorium, MD Anderson 

“Access to Antibiotics Without Prescription For Travelers and Colombian Citizens at Community Pharmacies in Bogota, Colombia” Marie Kasbaum, MPH – HGHC 2019 Grant Recipient- Baylor College of Medicine 

Samantha and Alicia’s Notes

  • Global Antibiotic Resistance Crisis
  • Community pharmacies in Colombia
    • 80% of antibiotic use happens in community settings rather than hospitals
  • Travel medicine
    • Increase in tourism in Colombia due to increasing political stability + growing travel infrastructure
    • Traveler’s diarrhea – most common disease contracted by international travelers worldwide (treated with antibiotics)
      • Recommended not to prescribe antibiotics unless severe 
  • Study: how access to antibiotics w/o prescription in chain pharmacies in Bogota, Columbia differs for local residents vs foreign US travelers 
    • Cross-sectional study 
    • Simulated client method (SCM) – trained clients w scripts interact with professionals who do not know they are observed 
    • Hypothesis: offers to sell antibiotics w/o prescription in community pharmacies occur at higher rate for customers who are foreign visitors compared to local customers
    • 94 pharmacies within Bogota (every single localidades — districts)
      • Throughout different SES stratifications 
      • Are practices similar or different 
    • Results:
      • >87% of pharmacies offered 1 antibiotic to the simulated groups
      • When pharmacies did offer antibiotics to the groups, they offered antibiotics at similar rates to both groups
      • Foreign travelers were offered antibiotics more without prompting 
      • Reasons for refusal:
        • More likely to give traveller group a clinical reason 
        • More likely to give local Colombian group a legal reason
      • Antibiotics often doubles as antimicrobials (often believed people had amoebas even though bacteria was more common) 
      • Within Colombian group
        • Higher rates of being offered antibiotics in lower income communities compared to higher income communities
      • About 40% of pharmacies didn’t ask either group any additional questions about the patient [even though interactions were conducted through the patient’s “friend” (in on the study) 
    • Conclusion: Antibiotics without prescriptions are way too accessible for both local groups
  • Limitations for study
    • Different gender of patients for foreign and Columbian groups 
    • Smaller sample size due to time constraints
    • Didn’t sample family pharmacies 
    • Recall bias – no audio recordings without consent 

 

“Mens Et Pedus: Building A Sustainable Future With Private-Public Partnerships For Clubfoot Treatment” Sergio M. Navarro, MBA – HGHC 2019 Grant Recipient- Baylor College of Medicine 
  • No presentation

 

“Designing Diagnostic Tools for Enteric Diseases in Children Under the Age of Five Years Old Living in Low- and Middle-Income Countries (LMICs)” Calbeth C. Alaribe, MPH – HGHC 2020 Abstract Presenter- Emory University 

Samantha and Alicia Notes:

  • ~500,000 children under 5 from LMICs die from enteric and diarrheal infections 
  • Diarrheal disease is 2nd leading cause of child mortality worldwide
  • Association btw enteric infections and environmental enteric dysfunction (EED) 
    • EED negatively affects child development, growth, health 
      • In 2017, ¼ children were stunted globally
      • EED considered a tropical disease/dysfunction
      • Poor response to oral vaccines 
  • EED
    • Poor WASH (water, sanitation, health) and contaminated food; microbes crate inflammatory response in small intestine
    • Small intestinal villi atrophy, crypts elongate; lose ability to act as barrier against pathogens and toxins – cannot absorb nutrients
  • Diagnosing EED
    • No specific/well validated diagnostic test available to identify and diagnose EED in children
    • Lactulose mannitol (L:M) ratio test — but unsuitable for children < 5 years
    • mRNA fecal transcripts, plasma tryptophan, bile acids, optical biopsy 
  • Factors to Consider in Designing Diagnostic Tools for EED
    • Study design, social and political environment, healthcare infrastructure, cost effectiveness, ethics (noninvasive diagnostic tests) 
  • Weaknesses in EED diagnostic studies
    • Majority ot studies were cohort studies 
      • Limitations with cross-sectional studies: temporality is poor; exposure + outcome are assessed at one point in time simultaneously — doesn’t provide strong evidence of relationship between altered metabolism and diagnosing EED 
    • Social and political climate
    • Healthcare infrastructure
      • A lot of studies talked about use of lab equipment, but didn’t actually address the healthcare infrastructure in that setting
      • In some global settings, samples had to be transported to the US in order to be analyzed 
    • Cost effectiveness
      • mRNA transcripts is much cheaper than L:M 
      • Important consideration for scaling the project to different parts of the world 
    • Ethics
      • Invasiveness of diagnostic test
      • Lactulose mannitol (L:M) ratio test could potentially cause fluid loss/diarrhea that would alter microbial gut community in children
      • mRNA transcripts would be better way to diagnose EED — this doesn’t interfere with intestinal microbiology
  • Recommendations for EED diagnostic tests

 

2:20-3:15

Global Health Communications 

Location: Research Institute, Houston Methodist Hospital 

Speakers: Peter J. Hotez, MD 

Natacha Poggio, MFA 

Barbara Gastel, MD, MPH 

Moderated by Monisha Arya, MD, MPH 

Alex and Alicia’s Notes:

Peter J. Hotez, MD is Dean of the National School of Tropical Medicine and a professor of pediatrics at the Baylor College of Medicine alongside being a Texas Children’s Hospital Endowed Chair in Tropical Pediatrics. Today, he discusses the role that physician scientists can have with the general media and public population in his presentation titled “Vaccine & Neglected Tropical Disease Diplomacy in an age of War, Political Collapse, Climate Change, Antiscience.”

  • Hotez and his team developed a SARS vaccine, which they’re now hoping to use for COVID-19
  • Interdisciplinary approach to global health: Placing things in a larger global context
  • Compares missteps of Trump’s administration when responding to COVID-19 and missteps of Obama’s administration when responding to ebola
    • High reproductive number coupled with increasing globalization in recent years are contributing to spread of COVID-19
  • Female genital schistosomiasis
    • Most common affliction of women living in poverty in African countries
    • Pian, bleeding, social stigma, depression
    • 2-3 OR in acquiring HIV/AIDS
  • Neglected tropical diseases (NTDs) included as “other diseases” under umbrella of Millenium Development Goal #6 (“Combat HIV/AIDS, malaria, and other diseases”)
    • Awareness of tropical diseases garnered by the publication of academic papers
    • “Hot Zones” of NTDs :Texas and Gulf Coast, Central Latin America, China and the Philippines, etc.
    • Political instability combines with climate change, urbanization, deforestation, or anti-science to create these hot zones
  • “Aleppo Evil” — transmitted by sandflies, which inoculate parasites that can cause permanent disfigurement 
  • Maduro regime, financial collapse, paralleled with worst drought in 40 years
    • 359% increase in Malaria; NTDs (leishmaniasis, Chagas, schistosomiasis, dengue/Zika) 
    • Measles epidemics due to interruption in national vaccine programs during this period 
  • Hotez calls Texas the “confluence of poverty, climate change, and urbanization”
    • Failures in advocacy — more than 60,000 children have been denied access to vaccines from 2018 to 2019 (this number doesn’t even include children who are getting homeschooled)

  • Scientists have been unwilling to engage the public 
    • Discipline/community of scientists is so inward looking that they have been unable to engage the public
  • “Vaccine diplomacy” — Hotez’s engagement with news channels during the COVID-19 panic and hysteria
  • Increase/development of knowledge is challenged/at odds with modern 
  • Q&A: 
    • “Have you ever thought about writing a book for healthcare professionals teaching them how to engage with the public?”
      • Believes that it should be taught in grad school, especially in doctoral studies
      • This younger generation has strong civic engagement and would benefit from that 
    • “How has your language adjust to engage folks and not turn them off”
      • Present language without the scientific jargon 
      • Hardest thing is to explain a scientific topic to a journalist (and not a scientific journalist)
  • Dr. Monisha Arya recommends that we reach out to the communications department in our own institutions as well 

Natacha Poggio, MFA explores the role environments play in our lives and challenges us to utilize global health communications to galvanize action in her presentation, “Global Health Communications, Stories to Inspire Action.” Some of her work includes drawing attention to care of people after cataract surgery, and nutrition and wellness for HIV farming communities. 

Poggio reminds us that different people view the world in different ways.

  • The world is very well connected in some areas, but completely disconnected in others.
  • Design is a powerful conduit for change.
    • Accessibility of design affects human activity and patterns
  • Design Global Change
    • An uncommon initiative in the graphic design field 
    • Projects implemented in South America, Africa, and India; examples include
      • Environmental issues
      • Prosthetic design and training

  • Project #1: Prosthetic Training Across Borders (collaboration with University of Hartford)
    • Built on the observation that “there is a strong connection between disabilities and poverty”
    • Translate to visual aids materials (with minimal text, text is usually in different languages) that can be passed out to patients by clinician resources
  • Water for India
    • Really interesting engagement with art as a medium to educate
    • Mural, banners
    • Visuals create possibilities for conversations
    • Very well received!!

  • Poggio also mentions that the “beautiful garments often worn by African women” were utilized as “billboards” to spread certain public health messages. 
  • Many other projects that utilized artforms to educate masses 
  • Poggio and Hotez agree that we can do a better job of informing the public about public health issues by using graphics

Bioterrorism and Public Health Emergency Preparedness 

Location: Onstead Auditorium, MD Anderson 

Speakers: Dario Gonzalez, MD 

Scott Patlovich, DrPH, CBSP, CHMM, CPH 

Carol Porter, DNP, RN, FAAN 

Moderated by Tara Prezioso, DVM 

 

3:25-3:30 

Opening Remarks 

Patricia Brock, MD – Board President of Houston Global Health Collaborative 

 

3:30-4:25

Keynote Speaker 

Stephen L. Klineberg, PhD, MA – Founding Director of Kinder Institute for Urban Research 

 

4:25-4:30 

Closing Remarks 

Sarah Chowdhury and Natalia Rodriguez- HGHC 2020 Conference Chairs 

LL

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