Duke Global Health Institute

Dhaka, Bangladesh: These women are recent graduates of BRAC's Ultrapoor program.
Weekly News and Notes
From the Duke Global Health Institute
 
Greetings!
     
Greetings!  Summer at DGHI has been busy with preparations for the Duke-Peking University Diploma program (which begins next week in Beijing); revamping the DGHI web site; and planning for a full slate of events in the Fall. Notably, starting on Aug. 3 the Duke Medical Library is hosting a national traveling exhibit on global health. Mark your calendar for Sept 3 when we'll co-host a reception to highlight the exhibit. Stay tuned to this space for more details. 
 
We are also excited to launch DGHI's Twitter and Flickr pages, and to update our Facebook Fan page and YouTube channel. Keep up with the latest in DGHI news, photos, videos and events by becoming a follower, subscriber and fan.
 
We welcome your feedback on all of these new ways to communicate with you.  And as always, send us your news to share. 
 
Until next time,
Geelea Seaford and Everyone at DGHI 

Summer In the Field
Women, prevention are priorities for fieldwork in Leogane, Haiti

 
By Alyssa Zamora, Duke Global Health Institute 
 
Duke University rising Junior Matt Gay is starting to believe that he can make at least a small difference in a world of immense health challenges. Gay and six other students are spending eight weeks this summer in Leogane, Haiti, an official field site of the Duke Global Health Institute. They have teamed up with Haitian student nurses to raise awareness about cervical cancer, a major killer of women in the country. 
 
"This interaction is only the first of a continued collaboration of ideas," says Gay, whose worldview has been influenced by the service trip. He says, "I am beginning to embark on a journey of encouraging and empowering nursing students to implement educational practices of their own."
 
The group of seven Duke students is immersed in the fieldwork program which is organized by Duke Engage and the Durham-based Family Health Ministries (FHM). FHM was founded by DGHI Affiliate and Duke Physician David Walmer, and plans to build a Family Health and Research Center in Leogane. This service trip focuses on addressing the health care needs for women, and GPS mapping and surveying of local health care facilities. While surveying the land in a rural community of 4,000 people, the students discovered that both the clinic and hospital had closed, leaving few health care options for its citizens.
 
"We were stunned," says Gay. "I thought about this rural village and how it represents a broader phenomenon of need that is pervasive throughout the Leogane community."
 
In an effort to introduce preventive health care services to more Haitians, Duke students are creating a brochure and short educational film on cervical cancer that will be translated into Creole and distributed to the Leogane community. Students are also encouraging hundreds of women to complete HPV screenings and to regularly get health checkups. At least 20% of the women recently tested at the Leogane clinic have tested positive for HPV. Junior Sunita Saith says as a result of their outreach, more women are returning to the clinic for follow-up appointments and treatment.

 
Students Trek Through Mountains Of Rural Haiti
 
The student group took a short break from their projects last week for a two-day hike through rural Haiti, led by FHM Executive Director Kathy Walmer. They hiked up the rugged mountains of Chaîne de la Selle in Southeast Haiti, which is home to the pine forests of La Visite National Park.

"Although tired and sore, the group was thrilled to have had the chance to spend time in rural Haiti," says Walmer. "Meeting the friendly, smiling people along the trail was all the encouragement the students needed to keep on walking."
 
The 30-mile hike was an unforgettable experience for Duke Senior Laura Ferraro who saw how the indigenous people lived in the mountains of Haiti. She recalled her conversation with a Haitian woman who said people die because they cannot afford health care. For those who live in remote villages, transportation to the nearest medical facility, which may be hours away by foot, is also unaffordable and often unavailable.
 
"I kept thinking about a woman, pregnant, about to give birth on the side of this epic mountain. Not only would she be experiencing pains much greater than my own, but she would have very limited options," says Ferraro. "Essentially her survival was entirely dependent on God or whatever divine presence she believes in."
 
The group also traveled to several other towns including Fort Jacques and Fondwa, where students visited an orphanage and played games with the children.
 
Other students on the trip include Juniors Ju Yon Kang and Max Kligerman, and Seniors Kevin Chen and Johnny Lai. They will complete their fieldwork at the end of July.
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Read more about Walmer's two-day hike in Leogane here.
Read the blogs of Duke students
Kevin Chen and Sunita Saith.

New method of HIV testing, monitoring holds promise for developing world
 

A new technique that detects the HIV virus early and monitors its development without requiring refrigeration may make AIDS testing more accessible in sub-Saharan Africa.
 
According to UNAIDS, sub-Saharan Africa accounts for almost a third of all new HIV infections and AIDS-related deaths globally. Yet there may be many people who do not get tested due to the high cost of treatment and minimal access to health care.
 
Duke Physician John Crump and a team of researchers recently completed a 10-month experiment at two remote sites in Tanzania. They examined Tanzanian infants born to HIV-infected parents and people with known HIV infections who needed monitoring of their viral loads. Viral load is a measurement used to diagnose HIV infection or determine the severity of HIV infection.
 
In the largest field study of its kind, researchers compared viral load measurements by using the current standard of frozen plasma and the alternative method of dried blood spots (DBS). The samples were measured at a central lab at the Kilimanjaro Christian Medical Centre in Moshi, some 250 and 350 kilometers away from the two study sites.
 
The Duke study found a strong correlation between viral load values in plasma and DBS, making the two testing approaches comparable. This finding could lay the foundation for a new way of testing for and monitoring patients with HIV in the future, according to Dr. John Bartlett, Duke Global Health Institute Associate Director for Research.
 
The sooner infants are diagnosed with HIV, the sooner they can receive life-prolonging medications to treat the disease. The infection cannot be detected in newborns using the typical HIV antibody test, and must be detected with other techniques, including viral load testing.
 
Viral load testing is also the optimal way for monitoring HIV infection in patients with known infections, especially for those receiving treatment.
 
But few labs in Tanzania perform the viral load procedure, and blood samples must be transported long distances to specialized medical facilities for testing. Plasma requires continuous cold storage during shipment, which can be challenging or impossible in resource-limited settings. This may prevent people from getting tested or result in inaccurate tests.
 
"Dried blood spots offer the advantage of not requiring cold storage," says Bartlett, who also points out that this method may result in lower total health care costs. "Before using it for care and treatment programs, it will need further evaluation. But, this is the largest field study of DBS's done to date, and the results appear promising."
 
The study findings were presented on Monday, July 20 in Cape Town, South Africa at the fifth HIV Pathogenesis, Treatment and Prevention conference. The event, hosted by the International AIDS Society, is the world's largest open scientific conference on HIV/AIDS with more than 5,000 attendees.  The study's lead author Sarah Lofgren is a third year medical student at Duke. This study was selected for distinction by the Conference Scientific Program Committee.
 
Additional information about the conference can be found at www.ias2009.org.

News Briefs and Announcements 
 
 

DGHI, George Institute Awarded Center of Excellence in Cardiovascular Disease in China
DGHI and The George Institute for International Health in Beijing, China have received funding to establish a Center of Excellence in Cardiovascular Disease in China.  Funded by the National Heart, Lung and Blood Institute and the UnitedHealth Group, DGHI will collaborate with existing health care systems in the region to build and strengthen sustainable programs in cardiovascular disease.  It will also foster the training and mentoring of emerging scientists, health professionals, and/or community health workers. View video and read more
 
 
Duke On Camera:  Meditation for African Orphans
A Duke team is helping to introduce mindfulness meditation to orphanages in Tanzania.  View video here
 
 
Update from the Program on Global Health and Technology Access
The Program on Global Health and Technology Access, a DGHI partner led by Dr. Anthony So, recently completed a project with UNICEF on the supply of ready-to-use therapeutic foods (RUTF) to the Horn of Africa. One of its key recommendations was to create a regional buffer stock to minimize local stockouts of the product among severely malnourished children undergoing treatment.  Read report. 
 
The Program has also launched the website "Humanitarian Supply Chain Analysis", which will help UNICEF and its multilateral and civil society partners understand how to apply supply chain analysis to other health commodities.

This project was conducted in collaboration with the UNC Kenan-Flagler School of Business and faculty from Duke (Gary Gereffi, Center on Globalization, Governance & Competitiveness) and UNC's School of Public Health. 
 
 
Duke Nursing Students Learn from International Opportunities
Contributed by the Duke School of Nursing Office of Global and Community Health Initiatives
 
Imagine, you are completing your clinical requirements and putting your nursing skills to the test. While on your way to the hospital or clinic you turn and catch a glimpse of the vast Blue Mountains of Jamaica, or pass the foothills of Mount Kilimanjaro in Tanzania.  Perhaps you are dwelling among the locals in a remote, rural village in Honduras, visiting the sick and elderly in rural communities in Barbados and Nicaragua, or attending to the sick in villages in South Africa.  Read complete article

 
CSIS Commission on Smart Global Health Policy Launches Web Site
 
There's a new, important resource for global health policy information now on the web.  The Commission on Smart Global Health Policy launched this new web portal this week. Click here
 
 
Sanford Becomes a School

Congratulations to the Sanford School of Public Policy on becoming Duke's tenth school.  Read more
 
 
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View our web site for more news.
Faculty Opportunities
 
 
Funding

Collaborative Research on Environment and Health in China, Rockefeller Brothers Fund

For additional funding opportunities, click here

July 21, 2009
Moshi, Tanzania: Boys in remote Maasai village
In This Issue
Summer Fieldwork Spotlight: Leogane, Haiti
News Briefs and Announcements
Faculty Opportunities
Upcoming Events
 
Upcoming Events
 
 
   
 
Aug 3-Sept 11  - Against the Odds: Making a Difference in Global Health Exhibit
(Duke Medical Center Library)
 
Sept 3, 5:30 pm -  Against the Odds Photo Exhibit Reception
(Duke Medical Center Library)
 

 
Click for more global health events
 
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Duke Global Health Institute is one of seven university-wide interdisciplinary institutes at Duke.  Learn more at www.interdisciplinary.duke.edu