Category Archives: Postcards

Avian Influenza A(H7N9) Perspectives in JIDC: Immune Status, The Elderly and Pandemics. by Stephen Huang

On 31 March 31 2013, the Chinese National Health and Family Planning Commission officially announced the emergence of novel avian influenza A(H7N9) virus infection in humans.  This virus has now caused disease in 108 people (as of 23 April 23), including severe cases and mortality.  Although the virus has not been shown to transmit from human-to-human, avian influenza A(H7N9) virus poses a pandemic threat in the human population due to the lack of pre-existing immunity and its high fatality rate, should human-to-human transmission occur.

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Figure 2 from Guan et al., 2013: Typical wet market in China showing staked cages of chickens, ducks and pigeons

In this issue of JIDC, Yi and colleagues of the International Institute of Infection and Immunity, Shantou University Medical College, Shantou, Guangdong, China, published a manuscript reporting a possible route via the mixed poultry-mammals  environment in the Chinese live markets as the source of avian influenza A(H7N9) virus human infections.

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Figure 3 from Guan et al., 2013: Typical wet market in China showing close proximity of multiple species including rabbits

Furthermore, based on the predominant number of severe cases in the elderly, the paper also puts forth the elderly population as at high risk for avian influenza A(H7N9) virus H7N9 human disease.

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Figure 5 from Guan et al., 2013: Number of nrH7N9 human cases per age group in
China as of April 15

The manuscript describes the lack of knowledge in designing effective H7N9 vaccines and immune surveillance, as well as lack of understanding in the disease’s pathogenesis, especially in the high-risk group.  This issue requires immediate attention for assessing a possible new pandemic outbreak.  The article can be found under this link: http://www.jidc.org/index.php/journal/article/view/23592638.

Stephen Huang

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Filed under China, Countries, Environmental Issues, Infectious Disease, Influenza, Outbreaks

Climate Change, Perspectives from Nepal

As a molecular biologist, my mind is frequently focused highly at the microscopic level.   I rarely consider the impact of large-scale environmental or cultural events on the very small molecules or microorganisms which coexist along side us.  Since reading Influence of environmental factors on the presence of Vibrio cholerae in the marine environment: a climate link, I now have an appreciation for the link between infectious diseases and the ecosystem; that is, how the visible affects the invisible or will eventually affect the visible.

 

The interaction between the weather and infectious disease status is an important area of research.  Many examples throughout history show how weather pattern changes and natural disasters lead to catastrophic disease outbreaks.  One recent example is the current outbreak of chloera in Haiti which occurred following the earthquake of 2010 (Kelvin AA JIDC 2011).  The earthquake, which devastated the country’s already weak water sanitization system, created a habitable environment for the colonization of the Cholera bacterium and facilitated the spread of the disease.  Perhaps my favorite article which reviews the interaction between climate change/weather and infectious disease outbreaks is an article by V. Sedas.  In this article, Sedas reviews how environmental factors have significant influence on the outbreak potential and pathogenesis of V. cholerae and other disease causing agents (Seda VT JIDC 2007).  As the fecal-oral transmission route of V. cholera relies heavily on the ecology of the native water supply, seasonal water cycles have been shown to affect the emergence and re-emergence of V. cholerae, thereby affecting the health of local populations (Seda VT JIDC 2007).  This article I highly recommend reading.

In this JIDC Postcard, Yadav Prasad Joshi reflects on how anthropocentric climate change is influencing health, lifestyle and ecosystems globally.  Yadav Prasad Joshi is a PhD student from Nepal and his post provides an invaluable perspective on climate change.

Alyson

Climate Change, Perspectives from Nepal

Have you ever thought about what might be considered the worst event to affect this planet? From wars to terrorism to nuclear emissions, the list is long, but few people would point out the events of climate change. Tsunamis, floods, heat waves, glacial melting and threats to biodiversity are all disasters that affect not only the people in the regions experiencing them, but everyone worldwide.

Weather and climate play a significant role in people’s health. Changes in climate affect average weather conditions. Warmer average temperatures will likely lead to hotter days and more frequent and longer heat waves, which could increase the number of heat related illnesses and deaths. Increases in the frequency or severity of extreme weather events such as storms could accelerate the risk of dangerous flooding, high winds, and other direct threats to people and property. Warmer temperatures could increase the concentrations of unhealthy air and water pollutants. Changes in temperature, precipitation patterns, and extreme events could enhance the spread of some diseases.

Global climate change has become one of the most visible environmental concerns (Bioterrorism) of the 21st century.  Climate change has brought about severe and possibly permanent alterations to our planet’s geological, biological and ecological systems. The Intergovernmental Panel on Climate Change (IPCC) now contends that “there is new and stronger evidence that most of the warming observed over the last 50 years is attributable to human activities”.1 These changes have led to the emergence of large-scale environmental hazards to human health, such as ozone depletion, the greenhouse effect, acid rain, loss of biodiversity, stresses to food-producing systems and the global spread of infectious diseases.1,2 The World Health Organization(WHO) estimates that 160,000 deaths, since 1950, are directly attributable to climate change.3

During the last 100 years, human activities related to the burning of fossil fuels, deforestation and agriculture have led to a 35% increase in CO2 levels in the atmosphere, causing increased trapping of heat and warming of the earth’s atmosphere. Eleven of the last 12 years (1995-2006) rank among the 12 warmest years in the instrumental record of global surface temperature. The IPCC reports that the global average sea level rose at an average rate of 1.8 mm per year from 1961 to 2003. The total rise in the sea level during the 20th century was estimated to be 0.17 metres and projected increase in temperature range is 1.8oC to 4.0oC by the end of this century .1,4

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These IPCC reports changes point to the drastic effects that climate change could have onlife in tropical counties and islands such as Vietnam, Mongolia, Laos, Philippines, Papua New Guinea, Nauru, Micronesia, and Tonga among others. Some of these Islands are only two to three metres above sea level and by viewing this trend of climate change, it is very difficult to predict the future of these countries.  The most common observed phenomena are increasing sea level, acidification, alteration in weather conditions, droughts, cyclones, extreme ENSO (El Nino Southern Oscillation) and EI Nino effects, etc.

Climate change has dramatically and negatively affected human health in the form of increased  burden of diseases of all types, in particular vector-borne illnesses such as dengue and malaria. Changes in climate increase the temperature, which in turn accelerates the multiplication of vectors by breeding, causes droughts which kill crops in some areas or floods which cause cholera in others, thus contributing either directly or indirectly to other diseases such as malnutrition and water-borne, air-borne, and food-borne diseases.

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Climate change associated with increasingly frequent and severe weather events and causes extensive infrastructure damage, economic slowdown, and interruptions of medical and psychiatric care, all which are likely to affect mental health in several ways. These events, and the lifestyle changes that can result, are associated with increased mental health burdens.5

Basically, there are two ways to  contend with climate change: adaptation and mitigation. The former is as a short-term solution that addresses only how to protect ourselves from adverse condition, whereas the latter is  a long-term process. Therefore, both should run simultaneously. Research area in the sectors of climate change should be highly prioritized and awareness program should be initiated from local levels. For all these activities, governments of all nations should responsible, and develop and implement proper national action plans for climate change.

Who is responsible for these overall hazardous conditions caused by climate change? The answer is human beings. Now the time has come to protect our lovely earth and to think about what we are leaving for our future generations. It is not the time to look for blame for problems such as increasing CO2 concentrations, clear-cutting of the forests and so on. t This is the time  for  all nations and human beings to unite with integrity to save the earth and protect the earth for our progeny.

It is my hope that every human will commit to protecting our planet from changing climate and its disastrous effects on human health.

More opinions in this context are highly welcomed. For further information, please contact the author at yadavjoshi@gmail.com

References

  1. McMichael AJ (2003) Global Climate Change and Health: An Old Story Writ Large. A. J. McMichael et al. editors. World Health Organization Geneva. 1-17.
  2. Sahney, S, Benton MJ, Ferry PA (2010) Links between the global taxonomic diversity and expansion of vertebrates on the land, Biology letters 6: 544-547. Available at: http://rsbl.royalsocietypublishing.org/content/6/4/544.full.
  3. McMichael AJ, Woodruff R, Hales S (2006) Climate change and human health: Present and future risks. Lancet  367: 859-869.

4. Climate change and health in Cambodia (2008) A vulnerability and adaptation assessment, WHO/MoH.

5. Roth P ( 2010) Climate change and health: mental health effects, News and views on climate, public health and environment. Available at: http://climatechangehealth.com/tag/ptsd. Accessed on: 1 March 2010.

Slide1Mr. Yadav Prasad Joshi is Nepalese and graduated from Tribhuvan University, Nepal, in Zoology and Psychology. He is extremely interested in infectious diseases and climate change. He joined the JIDC in 2007 as a Reviewer and Editorial Board member in 2012. Mr. Yadav Prasad Joshi has more than 10 years’ teaching experience in biological science to college, university, and medical students. He  participates equally in research activities, seminars, and book writing.  He has done research in tuberculosis, malaria, and many other public health issues.

Currently, he is a PhD student at Sungkyunkwan University, South Korea, in the department of Social and Preventative Medicine. His research topic is climate change and health.

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Filed under Cholera, Countries, Environmental Issues, Environmental Postcard, Infectious Disease, Nepal, Postcards

Marie Anne and the WHO investigate Cholera in Sierra Leone

I believe accurate reporting of infectious diseases, including diarrhoeal diseases, to be a significant issue of consideration in both developed and developing nations.  Accurate reporting by the individual, as well as by medical and government institutions, is imperative for analysis of infectious disease epidemiology. With accurate reporting, especially of cholera cases and cholera typing, appropriate therapeutic and preventative measures can be put in place. 

Here, Marie Anne Chattaway, a microbiologist from the UK, describes her experiences working with the WHO in Sierra Leone establishing an Enteric Bacteria Laboratory in Sierra Leone.  Their goal was to aid cholera diagnosis and reporting in this region.  I can’t thank Marie Anne (marie.chattaway@hpa.org.uk) enough for sharing her project.  I wish her and the taskforce every success in the future.

Thank you to Marie Anne, WHO and Sierra Leone.      

Alyson

Marie Anne and Cholera in Sierra Leone

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Picture 1: Map of Sierra Leone

I first became interested in developing countries when I started to volunteer for JIDC (The Journal of Infection in Developing Countries) a couple of years ago as a scientific editor and reviewer where the focus was mentoring scientists to publish their research in a scientific journal. I have been working with enteric pathogens for over five years at the Health Protection Agency of the UK and now realise just how much of an impact bacterial enteric infection has in developing countries. Until now, I had only managed to help from the UK, but the outbreak in Sierra Leone provided me with an opportunity to really use my microbiological skills where it was needed the most.

Cholera outbreak in Sierra Leone

Sierra Leone (Picture 1) has recently battled its worst cholera outbreak in 15 years. In

Picture 2: Crowded housing at risk of cholera

Picture 2: Crowded housing at risk of cholera

July and August 2012, the epidemic rapidly spread to all but one of Sierra Leone’s 13 districts. With a combination of crowded housing (Picture 2), unsafe water supplies, poor sanitation and the rainy season ahead, intervention was paramount. On 16 August 2012, the Sierra Leone government declared the outbreak to be a public health emergency, and established the Presidential Taskforce on Cholera. As of 2 October 2012, there had been 20,736 cases, including 280 deaths (case fatality rate or CFR=1.35%). The western area of the country where the capital city of Freetown is located was the most affected area with more than 50% of total cases. Initial training and some supplies were provided to the Central Public Health Reference Laboratory (CPHRL), Lakka and Connaught Hospital, in Freetown by the World Health Organization (WHO) and International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B).  The Global Outbreak Alert Response Network (GOARN) later requested a microbiologist to further evaluate laboratory facilities and provide technical advice and assistance to strengthen laboratory services for detection of cholera cases, capacity for confirmation by laboratory identification and for conducting differential diagnosis for main enteric pathogens (e.g., Vibrio cholera, Shigella, Salmonella, E. coli). The Health Protection Agency (HPA), UK, sent a microbiologist from the Gastrointestinal Bacteria Reference Unit (GBRU) to undertake this task from 10 October to 8 November 2012.

Travel to Freetown

The HPA was already involved with the cholera outbreak with a focus on epidemiology and case management; Sarika Desai and William Welfare from the HPA had already been deployed as WHO consultants. The specific request for a microbiologist to go to Sierra Leone for the month came later and though I had volunteered to go, in the end I had only 24 hours’ notice that I was on the flight the next day and that urgent supplies were needed. Needless to say, my two large suitcases were filled with consumables as well as clothes, a ridiculous amount of a range of pharmaceutical products (which I did end up using – unfortunately), and insect repellent (the insects still got me, though). I’m not sure what part of the journey was the worst: the bad turbulence on the plane with the woman behind me screaming; the small speedboat trip across the sea in the pitch black;  the jolting of the spine across the dirt tracks in the jeep;, or the sickness on arriving when adapting to the humidity and heat (as you know, we English are used to the cold). Either way, I did make it in one piece and was so happy that I didn’t crash in the plane and impressed by the stunning views (Picture 3) that actually I didn’t mind the bumpy roads.

Picture 3: One of the many stunning views in Freetown

Picture 3: One of the many stunning views in Freetown

Assessment of the laboratory

I was fortunate that there was a dedicated laboratory which had been selected to develop testing based at the Central Public Health Reference Laboratory (CPHRL) in Lakka. It was an hour away from the WHO office. Prior to intervention the department was faced with challenges of the lack of supplies, shortage of available trained staff, poor processing systems, and inadequate Health and Safety protocols in the enteric bacteria section of the CPHRL. The icddr-b had done a fantastic emergency response but further work was now required to establish and maintain an enteric bacteria laboratory in Sierra Leone.

Establishing an Enteric Bacteria Laboratory in Sierra Leone

Before training could even begin, a supplies stock system with the support of the WHO, HPA, CDC and Ministry of Health and Sanitation (MoHS) was set up to receive the required equipment and supplies. Molly Freemen from the Enteric Diseases Laboratory Branch of the CDC joined me for 11 days and the collaboration of all these organisations enabled the success of this mission. Intense training of multiple staff was necessary to maintain function after I left and the staff worked incredibly hard, even coming in at weekends and public holidays. A quality accredited process was set up, including the design of request forms for necessary information, the development of protocols for taking samples, receiving and logging the samples into CPHRL, and testing and recording results on the enteric result database for reporting (Picture 4). A surveillance link was also set up

Picture 4: Left to Right: Musu Abu entering laboratory results with Marie Anne Chattaway

Picture 4: Left to Right: Musu Abu entering laboratory results with Marie Anne Chattaway

so that regular weekly reporting of confirmed enteric pathogens is fed back. The two weeks of practical (Picture 5) and theoretical training was followed by intense three-day theory and practical competency testing. Staff were then certificated in “Isolation and identification of Vibrio cholerae, Salmonella typhi, non-typhoida, lSalmonella, Shigella sp. and E. coli O157” and “Health and Safety and Quality Systems in the enteric bacteria laboratory” (Picture 6).

Picture 6: Left to Right: Musu Abu, Fay Rhodes and Marie Anne Chattaway in Enteric Bacteriology, Quality and Health & Safety training

Picture 5: Left to Right: Musu Abu, Fay Rhodes and Marie Anne Chattaway in Enteric Bacteriology, Quality and Health & Safety training

Challenges and future Work

To sustain the new laboratory service, there is still much work to be done.  The supply system must be managed to ensure stock is available when needed.  Regular testing at the laboratory and reporting of results are essential for monitoring the cholera situation in the country. The biggest challenge will be the organisation and implementation of regular sample collection and transport to CPHRL.  Without regular samples from the districts, the testing competency and surveillance cannot be maintained. The impact of this part of the international response has been considerable; there is now a system for detecting and confirming cholera and other enteric pathogens within Sierra Leone.  If this laboratory component of surveillance is sustained it will lead to a better understanding of the incidence of cholera in the country and provide earlier recognition should the infection become epidemic again, thus enabling a rapid response.

Picture 6: Left to Right: Molly Freeman, Ahmed Foray Samba, Musu Abu, Slyvester Kamanda, Dr Abdual Kamara, Fay Rhodes and Marie Anne Chattaway. Other staff who participated and not in this photo include Eric Sefoi and Doris Harding.

Picture 6: Left to Right: Molly Freeman, Ahmed Foray Samba, Musu Abu, Slyvester Kamanda, Dr Abdual Kamara, Fay Rhodes and Marie Anne Chattaway. Other staff who participated and not in this photo include Eric Sefoi and Doris Harding.

Would I recommend this experience

Absolutely! It was an amazing experience, from networking and collaborating on an international scale with the most amazing and interesting people to experiencing the culture. I felt a real sense of achievement seeing how I can personally make a difference. It is hard work, working long hours with little breaks in sometimes difficult conditions, but the end result was worth any hardship. My favourite challenge was when I first opened the incubator to find lots of small ants favouring the Trypticase Soy agarplates. At first I didn’t think much of it, but when I looked at the plates carefully I saw tiny ant footsteps left by the insects that had walked on a cholera plate just after it had been inoculated. The ants had walked across the plate, dragging the bacteria with it (Picture 7). It is possible that perhaps there is a vector influence with the spread of some diseases that we wouldn’t normally consider!

By Marie Anne Chattaway

**Pictures taken by Marie Anne Chattaway, HPA.

Picture 8: Ant trail spreading cholera on a Trypticase Soy Agar plate (see line from top of plate to the bottom across the middle).

Picture 7: Ant trail spreading cholera on a Trypticase Soy Agar plate (see line from top of plate to the bottom across the middle).

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Filed under Countries, Infectious Disease, Postcards, Sierra Leone, Vibrio cholera

Introducing DR. Ana Carolina Ritter, PhD! Moving from PhD student to Post Doctoral Fellow

So you can’t wait to finish your PhD.  The years have been slowly slugging by.  It seems you have been at it for eternity…  And then BAM!!! You are done.  It seems it has come all at once.  So what comes next? What comes after the PhD is completed?  And importantly, now that you have finished (which is what you have been waiting for), it may be hard to know how to move on or what to do next.  I HAVE BEEN THERE. And so has Ana Carolina.

Ana last wrote of her interesting PhD research on Salmonella, telling us how she was able to study and conduct her lab work in both Italy and in her native Brazil.  Now Ana updates us with her exciting news that she has received her PhD.  She also shares how she navigated the difficult road from PhD to landing a postdoctoral fellowship in Bologna, Italy.

Good Luck Ana!

Alyson

Italy, I’m coming!

Hello! Good news, I’m going back to Italy … To do the postdoctoral research, this time in Bologna!

In my last blog post, I wrote a little bit about my experience completing part of my PhD at the University of Sassari… Since then, I have completed my PhD and the desire to return to Italy increased!

AnaPhD Talk

Ana’s PhD Seminar in Brazil

Therefore, while completing my doctorate, I sought out a group conducting strong research in food microbiology in Italy to do my postdoctoral research. After searching through PubMed, I found some papers published by the group led by Professor Maria Elisabetta Guerzoni.  I was very interested in the research they perform at the University of Bologna, more precisely in the Distal.  I contacted Professor Guerzoni and we were extremely well matched.

Upon receipt of her acceptance, I applied for a scholarship from a Brazilian funding agency for research, called “National Counsel of Technological and Scientific Development” (CNPq)1.  I outlined a project where I proposed working with new technology for disinfection of food, called Gas plasma2.  In late September I received a positive response from the Brazilian government, and will embark for Bologna in January 2013! Very cool huh?

Currently, it is exciting times for research in Brazil as the government is supporting researchers in bringing new technologies to Brazil by funding global travel for scientific education.  This initiative supports the development of competent professionals, through the granting of many scholarships to enable researchers to study in top universities worldwide.

I’m very excited as I am going through a new experience both in my personal life and academic life. And I hope that this partnership with the University of Bologna allows me to publish work as was the case happened with the University of Sassari3… And of course, I’ll be closer the Central Office of JIDC and old friends.

See you!

1: http://www.cienciasemfronteiras.gov.br/web/csf-eng/

2: Ragni, A., Berardinelli,A.,, Vannini, L., Montanari, C, Sirri, F., Guerzoni, M.B., Guarnieri, A. Non-thermal atmospheric gas plasma device for surface decontamination of shell eggs. Journal of Food Engineering 100 (2010) 125–132.

3: Ritter, A. C., Bacciu, D., Santi, L., Silva, W.O.B, Vainstein, M. H., Rubino, S., Uzzau, S., Tondo,E.C. Investigation of rpoS and dps genes in Sodium Hypochlorite Resistance of Salmonella Enteritidis SE86 Isolated from Foodborne Illness Outbreaks in Southern Brazil. Journal of Food Protection. Journal of Food Protection. , v.75, p.437 – 442, 2012.

AnaPhDParty

Ana’s PhD Graduation Celebration

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Filed under Brazil, Countries, Infectious Disease, Postcards, Salmonella

Focus on Maternal Health: The Domestic Agenda by Annie Feighery

Today Mother’s Day is celebrated here in Canada and in several other parts of the world.  The purpose of its inception was to be a day to honour your mother or to be honoured as a mother.  Personally, motherhood has been my most precious gift as well as my biggest challenge. Although cultures may differ globally, one common thread ties all women, and that is our universal love for our children.

I have asked Annie Feighery to write a post for Mother’s Day focusing on maternal health and maternal survival.  Annie, mother of 3 children, is a behavioural health scientist from New York City.  Her current project, The Domestic Agenda, focuses on improving maternal health care by working directly with mothers in lower income countries and using their opinions and experiences to build better health practices.  Below Annie has included two of her videos that showcase interviews with women to find out how they would like to improve their own health care.  I have an incredible amount of respect for Annie’s work and her perspective on improving maternal health care. I am overjoyed that she has agreed to write this post.    

Happy Mother’s Day to Annie and all the mothers around the world, including my own mother (who will always be the most incredible mother I could have ever imagined).

And thank you to my children for teaching me more than I have taught them and for making a mother out of me.

Alyson

Focus on Maternal Health and The Domestic Agenda by Annie Feighery

The global effort to eradicate extreme poverty is, at its core, an effort to make life more livable and joyful on a day-to-day basis for the 1.3 billion people on the planet who live on less than $1.25 a day1. The financial definition of extreme poverty eludes research efforts because poverty impacts a family in so many ways that have nothing to do with money. Health and well-being is intensely personal and has more to do with measures of elasticity and resiliency. Perhaps the worst of the impacts is the insidious way in which poverty can rob a woman of the joy of motherhood.

Maternal health is the world’s greatest social injustice.  Ninety nine percent of the world’s maternal deaths occur in impoverished countries2. The most common cause of maternal death is hemorrhage: bleeding out of control, without clotting during or after birth. The condition is almost entirely preventable with a $1 pill of misoprostal—available if mom gives birth in a clinic, and if her clinic has supplies3. For every maternal death, thousands more women survive birth only to live with a lifelong debilitating birth injury. Among the most common birth-caused disabilities is incontinence, which can result in a woman being shunned from her family and community. Still worse, the conditions of extreme poverty impact mental health at alarming rates, sometimes in excess of 35%4. More widespread than maternal morbidity and mortality is severe depression, which robs a mother of the joy of raising her children, of soothing their cries, of believing their survival is going to make the world a better place.

There has been very little innovation in maternal health in the 65 years of international global health. One system-level problem is that global health interventions are usually contract-based management structures. A contractor or NGO proposes and then measures outputs to produce based on their input of services. There is a management rule: what gets measured gets done. For child health, outputs are plentiful: upper arm circumference, weight for height, hair color changes or distended belly from malnutrition, developmental goals by time, etc. For maternal health, there are pregnancy indicators such as weight gain and delivery date, but aside from maternal death, a woman’s health provides too few measurable outputs. As a result, many maternal and child health programs focus almost entirely on the children. Accordingly, child survival is improving precipitously, while maternal survival lags far behind.

When I am observing a clinic over a period of time, without fail, the clinic is overflowing on market days—days when people drive from the more rural areas to town for buying and selling goods. On those days, I’ve seen clinics so busy that cleaning women are needed to come help the midwives attend the births. On market days, women are able to more easily overcome a significant hurdle to giving birth in a clinic: transportation. Back at the university, I proposed a study to demonstrate maternal mortality in a district reduces on market days. The head of the program said that, although maternal mortality is frequent enough to be a global crisis, on a local level it is too infrequent to easily get a significant sample size for a feasible study. The structural demands of research institutions contribute to the lack of innovation for these women.

I have been working on a film series to try to discover new interventions for maternal health by asking the women most at risk for maternal morbidity and mortality (death and injury) what would make things better for them. This crowd-sourced approach has shown me two things: first, women have amazing insights on their own health; and second, their solutions don’t line up very well with the current approaches in global health.

Women told me they know the standard for care at clinics is very low and there is often not enough equipment for them. I saw this firsthand when I shadowed a midwife in Uganda. There were not enough gloves for her to double glove or even change gloves between patients. Moreover, the gloves are not elbow-high, meaning she risked possible HIV exposure by manually removing placenta—often required to prevent hemorrhage. A ministry of health official told me attendance at clinics increases by a third when the radio stations announce there are Maama Kits at the clinics—the kits that provide the most basic supplies needed to attend a birth, such as gloves.

As a grad student, I once heard a professor talk admiringly about regions of the world where women have such self-control that they give birth silently. When I visit clinics in impoverished areas, I often see women slapped and derided if they yell out in pain. I think it’s not self-control that causes their silence, but fear of abuse and shame. The women I talk to say the treatment they receive in clinics is openly discussed between friends and family when they are deciding whether to go to clinic for birth or use a traditional birth attendant (TBA). As a behavioral scientist, I see a survivor’s bias that also influences the use of TBAs: no women who died in birth are present for those conversations. The women who had good experiences credit their TBA.

In communicating maternal health specifically or global poverty in general, I run into the problem that the women sound like victims of a system beyond their control. People don’t identify with a victim in a narrative. We all want to be heroes. If researchers and policy makers don’t identify with the individuals whose lives they’re working to improve, how can they succeed? My favorite part of crowd-sourcing new solutions to maternal health is this helps us see that these women are heroes. They know how to save their own lives. In fact, I have started gain framing the condition in my own papers: using a new term rather than maternal mortality in order to reinforce a sense of hope among even the research world: Maternal survival.

by Annie Feighery

Annie Feighery is a behavioral health scientist, entrepreneur, and mother of three in New York City. Annie is the co-founder of The Domestic Agenda, which is currently in production of a documentary about the global effort to crowdsource maternal health solutions. More information about the film can be found at http://www.TheDomesticAgenda.org/film. In addition, Annie is the co-founder of mWater.Co, a start-up offering mobile technology for water monitoring in low- and middle-income communities.

Annie can be followed online at twitter.com/anniefeighery

Reference List

(1)   The World Bank. Poverty Reduction and Equity. http://web worldbank org/WBSITE/EXTERNAL/TOPICS/EXTPOVERTY/0,,menuPK:336998~pagePK:149018~piPK:149093~theSitePK:336992,00 html [serial online] 2012.

(2)   Ghosh MK. Maternal mortality. A global perspective. J Reprod Med 2001;46:427-433.

(3)   Sheldon WR, Blum J, Durocher J, Winikoff B. Misoprostol for the prevention and treatment of postpartum hemorrhage. Expert Opin Investig Drugs 2012;21:235-250.

(4)   Wachs TD, Black MM, Engle PL.Maternal Depression: A Global Threat to Children’s Health, Development, and Behavior and to Human Rights.  Child Development Perspectives 2009;3;1;51-59

Read More: http://informahealthcare.com/doi/abs/10.1517/13543784.2012.647405. web [serial online] 2012.

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Filed under Health Care, Postcards

Dr. Asghar Nazeer – A recent JIDC author!

One of the things I love about JIDC is that it brings together so many people from so many different countries and cultures. When I first started the JIDC blog, I invited everyone in the JIDC community to contribute posts in which they share their science experiences working in a culture different from their own. We’ve had some great posts about adventures in Brazil, China, Vietnam and other places. This week, I am pleased to share Dr. Asgar Nazeer’s story. He is an accomplished scientist and medical doctorand a recent JIDC author.  Dr. Nazeer’sPostcard reflects his life as a researcher as well as his personal values thathe carries through to his work.  It is this kind of spirit and caring that drive the dedication behind JIDC. His story is inspiring!

Alyson

Dr. Asghar Nazeer, MBBS, MPH, MHS, DrPH (Johns Hopkins)

Dr. Asghar Nazeer, together with Dr. Jaffar Al-Tawfiq, is the author of a review article “Methicillin-resistant Staphylococcus aureus metrics for patients in Saudi Arabia” published in the March issue of JIDC.  JIDC came to know that Dr. Nazeer has been selected as a Member under Spotlight for March 2012 by the Delta Omega Honorary Society in Public Health. He was originally inducted into the Delta Omega Honorary Society in Public Health, Alpha Chapter (the society’s founding chapter) in 1994 at Johns Hopkins University and elected as a Lifetime Member in 1995. He is a committed member of the Delta Omega Mentor Network. Dr. Nazeer has more than 27 years’ experience in public health, epidemiology, and clinical medicine. Over the course of his career, Dr. Nazeer has been at the forefront of public health practice. He has won several medals, honors and awards in his homeland and in the United States. JIDC blog therefore took the opportunity to invite him to share his story regarding how he started his career and how his education and research in Johns Hopkins University transformed his calling as a doctor.

Dr. Nazeer originates from Pakistan. He a was an outstanding student throughout his high school and college years and won National Talent Scholarships and three gold medals including a Prime Minister of Pakistan Gold Medal for his academic achievements. He graduated in 1983 from King Edward Medical University, the most prestigious school of medicine in Pakistan. He worked as a physician for five years in leading centers-of-excellence offering post-graduate training programs in medical specialties. He was commended as a physician by his patients, superiors, and colleagues and was concentrating in clinical cardiology for advanced certification. However, he was touched by the suffering of his patients and realized that “prevention is better than cure” is not just a cliché but a sound fact. Instead of dealing with the illness of one patient at a time, he thought he should serve populations at large by promoting health and preventing disease. He then decided to leave the lucrative career of a physician and voluntarily adopted public health as his calling to serve the humanity for the greatest good of the greatest number.

As his first public health assignment, he joined the Federal Ministry of Planning and Development, Pakistan, as Assistant Chief of Health Section in 1989 where he contributed to health policy formulation and health-care planning at the national level. He participated in planning, implementing, and evaluating nationwide projects focusing on prevention. In that capacity, he represented his Ministry in projects involving collaboration between the Government of Pakistan and international agencies such as the WHO, UNICEF, World Bank, UNICEF and USAID.

His academic excellence and extensive experience in health policy and planning contributed to his winning the internationally competitive World Bank Graduate Scholarship Program’s Fellowship for studies at Johns Hopkins Bloomberg School of Public Health where he earned MPH, MHS, and DrPH degrees. He won the Advising, Mentoring and Teaching Recognition Award, William H. Draper Fellowship, and Friends of International Health Student Scholarship Award and was inducted into Delta Omega Honorary Society in Public Health, Alpha Chapter.

After completing his coursework for the Dr PH degree at Johns Hopkins, Dr. Nazeer had to leave the USA to attend to his ailing mother, who relied on him for her care and companionship. Dr. Nazeer answered her call without hesitation and gave up chasing his American dream at a juncture when he was winning honors and awards on many fronts. With her consent, he moved to United Arab Emirates where his several siblings worked so that his family could reunite there.

Dr. Nazeer worked for the Federal Ministry of Health, United Arab Emirates, from June 1995 to December 2003 as Senior Public Health Specialist with the Policy and Projects Department. He was involved in several projects and policy initiatives and had the opportunity to collaborate with the World Bank, WHO and other agencies as one of the Ministry of Health’s team members.

He wrote an outstanding dissertation, by utilizing his weekends and vacations while working full-time, which was lauded by his academic and thesis advisors and the dissertation committee. His dissertation focused on developing algebraic methods for evaluating validity and reliability of diagnostic and screening tests from their agreement data in the absence of a gold standard. He applied those methods to cervical cancer screening data for comparing them with the conventional methods. Dr. Nazeer holds women and children’s rights and their health-care priorities in his highest regards. He accordingly named his dissertation as R and Z Conceptual and Analytical Framework as a tribute to his wife’s dedication and sacrifices and his autistic son’s angelic innocence by putting the initials of their names in his dissertation’s title. He truly believes that behind every successful man there is a woman and considers his wife, who is also a physician, as his best friend ever. He also commends the great sacrifices of his mother for supporting him in getting the best education and laying a strong foundation of his career.

Dr. Nazeer resigned from his position in Ministry of Health UAE in 2003 to take on a new assignment as Senior Epidemiology Specialist in the Preventive Medicine Services Division of Saudi Aramco Medical Services Organization. He is still working in the same organization.

In short, Dr. Nazeer graduated as a physician and practiced clinical medicine for five years. He then decided to become a public health professional and obtained his higher education from Johns Hopkins University. His first two years of education in Johns Hopkins Bloomberg School of Public Health were funded by the World Bank Fellowship. He believes that the prayers and untiring support of his mother and his wife, the World Bank’s Fellowship, and studying at Johns Hopkins University transformed his life from a physician to an earnest public health professional who strives to serve the humanity at large on a population level rather than in a clinical setting. To contact him or learn more about his work, click to access his Linkedin profile.

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Welcome JIDC Brazil Regional Office!

JIDC opens Brazil Regional Office!

It is with great joy that we announce the opening of the JIDC Regional Office in Brazil!

When I was in Sardinia doing a part of my PhD project (My JIDC Post), I had the opportunity to participate in a JIDC meeting that took place in Stintino. It was fascinating, because I could see firsthand how a scientific journal operates and also how much work is behind these publications.
When I returned to Brazil, I thought several times about proposing to Professor Salvatore Rubino the establishment of a JIDC regional office in Porto Alegre. Publishing is very important for our country as well as other countries that are aiming to establish themselves. Also, when I looked through the JIDC archives, I noticed that there were few publications focusing on research conducted in Latin America by Latin American scientists.

In July 2011, I had the opportunity to return to Sardinia (this time for a wonderful vacation) and reconnected with old friends Marco Scano and Giustina Casu as well as meet new friends in Sassari. When I learned that they were going to Argentina for a holiday, I suggested they to come visit me in Porto Alegre to take advantage of a conference at the University where I am taking PhD (UFRGS) to speak a little of JIDC. We spent five wonderful days during which Marco talked to the students and teachers in my graduate program about the submission of papers and also the published JIDC items online. On this visit, we started talking a little more seriously about the creation of a JIDC regional office in Porto Alegre.

And here we are! Announcing the arrival of the Regional Office! Wonderful, is not it? The JIDC Brazil Regional office is strategically settled in the Food Microbiology and Food Control Laboratory, located in the Food Science and Technology Institute of the Federal University of Rio Grande do Sul (ICTA/UFRGS). This Institute was the first specialized food institute of Brazil, founded in 1958.

ICTA/UFRGS offers diverse undergraduate courses in areas such as food engineering, nutrition, pharmacy, chemical engineering, chemistry, and biomedicine in addition to several graduate courses related to food science and food technology working toward Masters and PhD degrees s in Food Science and Technology. The faculty has strongly collaborated with the post-graduation programme in agricultural and environmental microbiology.
The Food Microbiology and Food Control Laboratory of ICTA/UFRGS has several research projects, mostly linked to the investigation of food pathogens and food safety. The projects focus on solving food industry, food services and governmental problems related to food production. The head of this Laboratory is Professor Dr. Eduardo Cesar Tondo, who has been working with Food Microbiology and Food Quality for almost two decades, and is a research collaborator of Prof. Dr. Salvatore Rubino of Università Degli Studi di Sassari.
The main objective of the Brazil Regional office is to promote JIDC awarenessamong scientists, medical doctors, students and the general community of Brazil and neighboring countries, as well as to help all the colleagues of JIDC in scientific activities related to Brazil and Latin America.
We happily acknowledge the visit by Marco and Giustina, cultured and wonderful people, who showed great curiosity to know our country and customs. We are grateful to Marco Scano for his informative seminars which solidified the decision to implement the regional office in Porto Alegre. We especially thank Dr. Salvatore Rubino and the rest of the JIDC team for their confidence in our ability to join them in their endeavours.

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