Liveblog: 8th Annual Houston Global Health Collaborative Conference, Day 2

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2020 HOUSTON GLOBAL HEALTH COLLABORATIVE

On March 7, 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. 

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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