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Global Health, HIV/AIDS, Medical Education, Medical Schools, Stanford News

Stanford med student chronicles his experience working in rural Kenya

Stanford med student chronicles his experience working in rural Kenya

Hodgkinson and others in Kenya

Growing up in Kakamega, a rural county in western Kenya, medical technologies and services were extremely limited for Luqman Hodgkinson, PhD. Now a first-year Stanford medical student, Hodgkinson is spending the summer months back in his hometown conducting research and chronicling exciting new developments in medical education – the opening of the first medical school in the region.

With a population of nearly two million, Kakamega is the second largest county in Kenya behind only Nairobi. But with only 12 physician specialists, the vast majority of residents don’t have access to advanced care.

Earlier this year, Masinde Muliro University of Science and Technology (MMUST), a leading public university in Kenya, received authorization to become the very first medical school in Kakamega; it’s expected to enroll its first class of students this fall.

Hodgkinson has received a faculty position as an adjunct associate researcher at the new MMUST School of Medicine and will serve as the designated ambassador from MMUST to Stanford.

As Hodgkinson writes in his first blog entry en route to Kakamega, “Relationships are very important in medicine and this is also true for a medical school that is at the beginning of a bright future.”

His first research project in Kakamega focuses on the efficacy of community outreach programs designed to improve adherence to antiretroviral medications among adults with HIV/AIDS. Under the mentorship of Michele Barry, MD, FACP, senior associate dean for global health at Stanford, Hodgkinson is working with Emusanda Health Centre to evaluate the efficacy of these programs and demographic factors that may impact medication adherence.

He writes in his blog: “Medical research of all kinds is greatly needed in Kakamega to advance the health of the community, particularly in the area of HIV. In Kakamega County, the HIV prevalence is 5.6 percent. Addressing the local HIV pandemic is what inspired me many years ago to pursue medicine and now for the first time I am on my way to join this endeavor.”

Hodgkinson will be blogging from Kakamega throughout the summer, sharing updates from his research activities and collaborative opportunities for members of the Stanford community to get involved with the new MMUST School of Medicine. Follow along on the Center for Innovation in Global Health website.

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Photo – of (left to right) clinician Jorcelyne Makori, peer educator James Okwiri and Hodgkinson – courtesy of Hodgkinson

Chronic Disease, Global Health, Health Policy, Public Health, Research, Stanford News

Finding the sweet spot in public health law to regulate sugary drinks

Finding the sweet spot in public health law to regulate sugary drinks

lemonade-155663_1280Two Stanford public health law experts say one of the biggest culprits of the obesity epidemic – on top of fast foods and sedentary lifestyles – is sugary drinks. And they believe the sweet spot for public health law in curbing the adverse effects of sugar-sweetened beverages (SSBs) lies in the strategic use of measures such as higher SSB taxes, limits on advertisements targeting kids, and restrictions on soft drinks and sugar-sweetened teas and sports drinks in government institutions, such as public schools.

“Enough is already known about the promise of some legal interventions to curb SSB consumption – significant tax hikes and advertising restrictions are two good examples – to be fairly confident that they would make a difference,” says David Studdert, MD, a professor in the medical and law schools and a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research.

Studdert is the lead author of a review paper, “Searching for Public Health Law’s Sweet Spot: The Regulation of Sugar-Sweetened Beverages,” which was published today in PLoS Medicine.

Studdert and senior author Michelle Mello, MD, also a professor in the medical and law schools, and co-author Jordan Flanders, a former Stanford Law School student, argue that sugary drinks are a substantial, yet preventable contributor to the global burden of obesity and associated health conditions.

A recent study in the journal Circulation linked the consumption of sugary drinks to an estimated 184,000 adult deaths each year, with more than 25,000 of those Americans. While Americans’ consumption of sugary drinks has plateaued, according to the research, about three-fourths of the deaths due to SSBs are now in developing countries. Mexico leads with 24,000 total deaths. The United States still ranks fourth, however, just behind South Africa and Morocco.

The Stanford researchers say the evidence shows that sugary drinks are contributors to the global obesity epidemic, but the appropriate reach of regulation to curtail SSB consumptions remains highly contested.

“Finding public health law’s sweet spot requires regulatory approaches that are capable both of achieving measurable improvements to public health and of winning victories in courts of law and public opinion,” they wrote.

That’s often difficult.

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Emergency Medicine, Ethics, Global Health, Medicine and Society, Patient Care

After Haiyan: Stanford med student makes film about post-typhoon Philippines

After Haiyan: Stanford med student makes film about post-typhoon Philippines

Multi-talented Stanford Medicine student Michael Nedelman has been featured on Scope before for his filmmaking and storytelling abilities. His new film, “After Haiyan: Health narratives in the aftermath of the typhoon,” is a series of vignettes about the November 2013 disaster in the Philippines. The film, which will be released soon, connects socioeconomic and structural issues of access to health in times of crisis.

It was filmed primarily in Tacloban, Leyte, in July and August of 2014, and Nedelman made a follow-up visit in November and December to premiere and promote the project. Despite his busy end-of-school-year schedule, Nedelman answered some questions for me about his work in a recent email exchange.

What was it like filming in the wake of a tragedy? 

Phil Delrosario said it best. He’s the cinematographer and editor I met here at Stanford. Knowing when to turn on the camera was a “huge balancing act” between our drive to document the truth, and our obligation to be compassionate storytellers. We couldn’t ignore the emotional weight of Typhoon Haiyan, and we couldn’t ignore the fact that we weren’t part of the communities we were documenting. So we sought out people who not only wanted to share their stories with us, but who could also provide some insight as to how they wanted those stories to be seen… For one of the videos, Deaf advocates like Noemi Pamintuan-Jara reached out to us first, not the other way around… That was really special for us, to be able to work alongside a community that has been promoting Deaf accessibility and culture long before we ever arrived on the scene. And we had these new partners who could give meaningful feedback on our filmmaking decisions.

Filming in the wake of a tragedy doesn’t mean everything is tragic. The shadow of Haiyan is still there, but there’s also a sense of living in the moment and moving forward. All over the city, you’ll see posters and graffiti that say, “Tindog Tacloban!” (“Rise Tacloban!”) That’s something that really resonated with our team and the ethos of our project. You can’t tell the full story of Tacloban without optimism and resilience.

How does this film link storytelling and health, and what is special about that for you?

When I was first discussing the project with one of the producers, Roxanne Paredes, we asked ourselves a similar question: How would our project add to or nuance the coverage of the typhoon? Right after the storm, Haiyan was all over the news. Tacloban was in survival mode. But months later, after many of those cameras had left, there was a different set of long-term challenges and a focus on recovery. Those were the issues we wanted to explore, which tend to be less covered by the media but still have profound implications for community health and future disaster preparedness. In short, just because the cameras stopped rolling doesn’t mean there weren’t more stories to tell. That really broadened the way in which I think of health stories.

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Global Health, HIV/AIDS, Infectious Disease, Public Health, Research, Rural Health

Drought causes spike in HIV infections in Africa

Drought causes spike in HIV infections in Africa

75148497_50e081cd5b_zHere in California, the drought is plenty serious. Shortages mean short showers, brown lawns, empty reservoirs and fallow fields.

But in sub-Saharan Africa, drought spreads disease, including the still-rampant HIV virus. The phenomenon is more sociological than ecological: Slim harvests slash farmers’ incomes, forcing them to find new ways to earn money. Some turn to sex, according to a new study in The Economic Journal.

As described in a recent article from Stanford’s Center on Food Security and the Environment (FSE):

Analyzing data on more than 200,000 individuals across 19 African countries, the research team finds that by changing sexual behavior, a year of very low rainfall can increase local infection rates by more than 10 percent.

That means condoms and sex education aren’t all that’s needed to thwart the epidemic’s spread, the study’s authors say. Affected farmers also need economic support and alternatives to help them weather the dry period, without sacrificing their health.

“These are the people who really suffer when the rains fail, and who are forced to turn to more desperate measures to make ends meet,” co-author Marshall Burke, PhD, a fellow at the FSE, said in the piece.

Previously: Spread of drug-resistant HIV in Africa and Asia is limited, Stanford research finds, Stanford study: South Africa could save millions of lives through HIV prevention and Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa 
Photo by Jon Rawlinson

Bioengineering, Cardiovascular Medicine, Global Health, Stanford News, Technology

Stanford-India Biodesign co-founder: “You can become a millionaire, but also make a difference”

Stanford-India Biodesign co-founder: "You can become a millionaire, but also make a difference"

This post is part of the Biodesign’s Jugaad series following a group of Stanford Biodesign fellows from India. (Jugaad is a Hindi word that means an inexpensive, innovative solution.) The fellows will spend months immersed in the interdisciplinary environment of Stanford Bio-X, learning the Biodesign process of researching clinical needs and prototyping a medical device. The Biodesign program is now in its 14th year, and past fellows have successfully launched 36 companies focused on developing devices for unmet medical needs.

4499846308_9f084d26f0_zThe three Indian biodesign fellows who were at Stanford for the past six months have returned to New Delhi, where they’ll finish up their fellowship. They’re the last class of fellows from the Stanford-India Biodesign program, and in India they’ll be joining two teams already in progress as part of the new School of International Biodesign (SIB).

Balram Bhargava, MD, executive director of Stanford-India Biodesign (India), was at Stanford for the fellow’s final presentation of their prototype. He helped establish the relationship between Stanford and India and is now revamping the new self-sufficient program.

How did Stanford-India Biodesign originate?

I was at a retirement party in September 2006 for Ulrich Sigwart, MD, who developed the first stent. He called in some friends from all over the world, including Paul Yock, MD (director of the Stanford Biodesign Program). Paul and I shared a taxi ride to Ulrich’s vacation home and got talking. That’s when the program started. By January 2008 the first batch of fellows was here.

The basic intent was to start this innovative program in India and ultimately make it self-sufficient. We selected students from India and sent them to Stanford, then they finished out their fellowship in India.

How has the program changed over the years?

Our early fellows returned from Stanford with high-end ideas such as robots. I had to pull them all down back to the ground. My role was to give this program a soul, and I think I have been successful at that. After a few years Stanford also accepted that frugal design was the right thing for the world and I’m happy about that.

Many of our students had the intention of setting up a company and becoming millionaires. We’ve given them the idea that you can become a millionaire, but at the same time you can make a difference. That’s the delicate balance we want to teach. The students have been very bright and many of them have really delivered on this dream.

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Behavioral Science, Global Health, In the News, Public Health, Research, Sleep, Technology

Electricity access shortens sleep, study shows

Electricity access shortens sleep, study shows

Radium_Dial_UVGrowing up, my engineer father always told me to move my flowery glow-in-the-dark clock farther from my bedside. “You’re nuts, Dad,” I would respond, equating his concern with his conviction that he was dropped off by aliens in the New Mexican desert in 1947.

But now it turns out he may have had a point (although I’m still quite sure he came from a hospital in Pennsylvania, not a spaceship).

A new study published in the Journal of Biological Rhythms has shown that access to artificial light at night has shortened the amount of time we sleep each night. A recent University of Washington release describes the study:

The researchers compared two traditionally hunter-gatherer communities (in Argentina) that have almost identical ethnic and sociocultural backgrounds, but differ in one key aspect – access to electricity…

In their usual daily routines, the community with electricity slept about an hour less than their counterparts with no electricity. These shorter nights were mostly due to people who had the option to turn on lights and go to bed later, the researchers found. Both communities slept longer in the winter and for fewer hours in the summer.

This is the first study to examine differences in communities, rather than relying on artifically manipulating light in a laboratory.

“In a way, this study presents a proxy of what happened to humanity as we moved from hunting and gathering to agriculture and eventually to our industrialized society,” said lead author Horacio de la Iglesia, a University of Washington biology professor. “All the effects we found are probably an underestimation of what we would see in highly industrialized societies where our access to electricity has tremendously disrupted our sleep.”

So douse those lights, turn off the TV, push back your glowing clock, and embrace the dark — with a nice, long snooze.

Previously: New recommendation: Adults need at least 7 hours of sleep each nightMobile devices at bedtime? Sleep experts weigh in and Can adjusting your mobile device’s brightness help promote better sleep?
Via Medical News Today
Photo by Arma95

Global Health, Health Disparities, Health Policy, Stanford News

Rosenkranz Prize winners devoted to innovative health care in developing countries

Rosenkranz Prize winners devoted to innovative health care in developing countries

African girls studyingMarcella Alsan, MD, PhD, knows that the division of labor among men and women starts at a young age in the developing world.

“Anecdotally, girls must sacrifice their education to help out with domestic tasks, including taking care of children, a job that becomes more onerous if their younger siblings are ill,” Alsan, a core faculty member at the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) within the Freeman Spogli Institute of International Studies, recently told me.

More than 100 million girls worldwide fail to complete secondary school, despite research that shows a mother’s literacy is the most robust predictor of child survival. So Alsan is analyzing whether medical interventions in children under 5 tend to lead their older sisters back to school. She’ll compile data from more than 100 Demographic and Health Surveys covering nearly 4 million children living in low- and middle-income countries. The surveys ask about episodes of diarrhea, pneumonia and fever in children under 5 and record data on literacy and school enrollment for every child in the household.

“My proposed work lays the foundation for a more comprehensive understanding of how illness in households and early child health interventions impact a critical determinant of human development: an older girl’s education,” Alsan, the only infectious-disease trained economist in the United States, said.

Alsan is one of two winners of this year’s Rosenkranz Prize for Health Care Research in Developing Countries, awarded by CHP/PCOR. Her Department of Medicine colleague, Jason Andrews, MD, is the other recipient of the $100,000 prize, which is given to young Stanford researchers to investigate ways to improve access to health care in developing countries.

In the current scientific climate, most National Institutes of Health grants go to established researchers. The Rosenkranz Prize aims to stimulate the work of Stanford’s bright young stars – researchers who have the desire to improve health care in the developing world, but lack the resources.

While Alsan is researching how older girls in poorer countries are impacted by the health of their younger siblings, Andrews is focusing his attention on cheap, effective diagnostic tools for infectious diseases.

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Global Health, Health Policy, Medicine and Society, Public Health, Stanford News

The battle against big tobacco hits the classroom

The battle against big tobacco hits the classroom

4822770407_f1a230b06c_bIn Malawi, children as young as five years old work in tobacco fields. Here, in the Silicon Valley, five-year-olds compete to attend top preschools. Stanford communications major Minkee Sohn highlighted that dramatic contrast with a parody video, “Fresh Recruits,” for a new Stanford anthropology class. Taught by Matthew Kohrman, PhD, the class, “Smoke and Mirrors in Global Health,” aimed to raise awareness about the global tobacco industry and was the subject of a recent Stanford News article.

Simply acknowledging that “smoking is bad for you” is no longer enough to halt tobacco’s spread. As noted in the piece, the tobacco industry remains a powerful global force and produces three times as many cigarettes as it did during the smoking heyday in America in the 1960s; it’s also the source of millions of preventable deaths. Kohrman encouraged his students to develop original communication strategies and to take on hard-hitting issues, such as the use of underage labor.

For their final projects, Kohrman’s class presented a slew of web-based videos, exposés and written critiques exploring little known facets of the global tobacco industry, including:

  • Chinese academia’s involvement in the tobacco industry
  • Philip Morris’ use of child labor in Africa
  • South Korea’s flawed approaches to tobacco control

Overall, Kohrman, an associate professor of anthropology, deemed his experimental class a “great success.” The course uncovered many little-known aspects of global tobacco, and taught students to “understand the sociocultural means by which something highly dangerous to health such as the cigarette is made both politically contentious and inert.”

Alex Giacomini is an English literature major at UC Berkeley and a writing and social media intern in the medical school’s Office of Communication and Public Affairs.  

Previously: A call to stop tobacco marketing, Cigarettes and chronographs: How tobacco industry marketing targeted racing enthusiasts and How e-cigarettes are sparking a new wave of tobacco marketing 
Photo by Jo Naylor

Global Health, Nutrition, Pediatrics, Stanford News, Technology, Women's Health

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Stanford initiative aims to simultaneously improve education and maternal-child health in South Africa

Nomfusi_counselingWhat if we could “leapfrog” over the education and technology gap in low-resource countries, while at the same time improving maternal and early childhood health in those areas? That is precisely the promise of a new Stanford-sponsored initiative spearheaded by Maya Adam, MD, a lecturer in the human biology program here.

I recently had the chance to speak on the phone with Adam and hear more about this project, which consists of designing picture-based educational videos that are loaded on tablets and distributed among community-health workers. At present, the video on child nutrition is being used as a pilot in South Africa through the organization Philani, where twelve “mentor mothers” have been using the tablets since March. As you’ll read below, there is immense potential for the project to scale up in the near future.

What have the results of this initiative been so far?

The feedback that we’ve gotten was that a lot of the mothers being counseled said, “You know, you’ve been using phrases like ‘balanced diet’ for many years, and I didn’t quite know what that meant until I saw the plate with the green vegetables and the little bit of protein and the little bit of grains.” Certain phrases became clearer when they were drawn in pictures. Also, we found a lot of the children wanted to come watch because it was a screen-based activity.

The workers themselves found it useful to convince their patients, for example, of the importance of prenatal care, because when the patients heard it both from the video and from them, it was almost as if the video was validating their messaging. So they’re very eager to have the project continue. They have a whole list of other videos they want us to make, from breastfeeding to HIV/AIDS prevention… It’s really been a powerful way both to teach and give these highly intelligent women access to technology that could enhance their education and help them overcome the barriers in their lives.

How easy would it be to use these videos in different regions of the world? 

slider-9_compressedWe have videos translated into English, Xhosa, and now Spanish, because they’ll be used next in Guatemala… We can use English in the U.S. in under-resourced locations. These are all very universal messages, and that’s why it’s so exciting: For a relatively small amount of effort, we can make videos that can be both translated into many other languages, and subtly altered visually so they resemble women and children in each different part of the world. For example, while we were creating the video, we put the braids that African women traditionally wear in their hair on a different layer of the Photoshop, so that layer can be removed and the resulting woman will have straight dark hair that would be more appropriate for use, say, in Guatemala.

We thought a lot about how to represent food. A real plate of food from South Africa would be culturally inappropriate in Guatemala, but by using cartoon images of fruits and vegetables, it becomes much more universal… We tried to show a variety of different fruits and vegetables without specifically showing that “this is a guava,” because a guava might not grow in other parts of the world.

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Cancer, Global Health, Medicine and Society, Patient Care, Stanford News

Educating cancer patients in Africa and beyond

Educating cancer patients in Africa and beyond

ph_grid7_20554_74781Imagine beginning chemotherapy without being aware of the side effects. You’re feeling sicker than you felt before the medication, experiencing nausea, muscle weakness and losing your hair. You wonder if this is normal, but you can’t interpret the drug safety information because you don’t know how to read. You’re tempted to stop taking the medication.

Realizing that many of their patients had grappled with this dilemma, cancer care providers at Queen Elizabeth Central Hospital in Blantyre, Malawi approached Global Oncology, a non-profit co-founded by Ami S. Bhatt, MD, PhD, for help.

With one oncologist and an overstretched clinical team, clinicians at Queen Elizabeth recognized they often don’t have time to explain the chemotherapy treatment process to each patient. And, many of these patients struggle to read and comprehend complex instructions and medical terminology.

So they decided to create clinically relevant and culturally appropriate education materials designed for a low literacy patient population.

Veronica Manzo, a first-year medical student at Stanford and a member of Bhatt’s lab, is part of a team of Global Oncology volunteers developing the educational materials. She began volunteering with GO while she was working at the Dana-Farber Cancer Institute and is working to establish a chapter of the GO Young Professional Alliance at Stanford. The group held its inaugural meeting on campus last month.

cancer pamphlet“The existing materials were often too high-level for low literacy patients – wordy, complex and not designed for that culture or audience,” Manzo told me. “We looked at the most common chemotherapies in Malawi and created materials designed to target the specific side effects associated with the treatment.”

Together with Cambridge-based design firm, THE MEME Design, Manzo and a team consulted with medical and health-literacy experts to simplify complex medical information – incorporating simple language and culturally relevant illustrations – and package it in a way that could be easily printed and distributed by partners in low resource settings. The final 8-page booklet, “Cancer and You,” was introduced at Queen Elizabeth last summer and has become a helpful tool that educates patients and caregivers and improves treatment adherence.

Since the project began in 2013, the team has also collaborated with Partners in Health to modify and implement the materials in Rwanda and Haiti, and they hope to expand the work to Guatemala, India and additional sites in Africa and South America. To help support this expansion, Global Oncology has launched a 30-day fundraising campaign through Global Giving with the aim to raise $5,000 from 40 donors by the end of June.

“It’s exciting to see the positive impact the patient education materials have had in Malawi and Rwanda, and we’re looking forward to expanding this initiative to help close the gaps in patient cancer education worldwide,” said Bhatt, director of global oncology at the Center for Innovation in Global Health.

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.

Previously: Oncology hashtag project aims to improve accuracy of online communication about cancer, Stanford fellow addresses burden of cervical cancer in Mongolia and Providing medical, education and technological tools in Zimbabwe
Images by Global Oncology and THE MEME Design

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