Diabetes, Chili Beans, and A1C's: Project HOPE in Action

The A1C, or HbA1c, is a common test for diabetes that measures levels of glycated hemoglobin in an individual's blood stream.  When diabetes is not controlled, sugar buildup in up in blood is detected as sugars are glycated, or bound, with hemoglobin.

A chili cook-off in central Virginia might be the last place one would expect to find a group of medical students with handheld A1C machines.  But among the steaming pots of chili - where tasters wore camouflage coats and a guitarist covered hits of The Band and Bob Marley - citizens of Louisa, VA checked their blood sugar.

On Saturday November, 1st, patrons of the Earlyhouse 10th Annual Charity Chili cook-off also checked their blood pressure, discussed healthy food options with a dietician, and checked their kidney function.  It was overcast and windy, a perfect day for chili but also an ideal day for Project HOPE to do what it does best: interact with the local community and promote health through disease screening.

Ebola Panel: Action Now and in the Future

On her way out of the medical auditorium, Dr. Christiana Hena taught us the Liberian handshake. As you pull your hand away, you snap your finger against the other persons. But now in Liberia, people don’t shake hands like that anymore. They give each other a thumbs up. The reason: Ebola.

Today’s panel discussion allowed us a more intimate understanding of the effects the viral epidemic has inflicted upon West Africa over the course of a few short months, beyond the commonly cited numbers in the media. The loss of intimacy in everyday life cannot be as easily quantified as mortality statistics.

As Dr. Hena and the other panelists spoke (virologists, a WHO consultant and two anthropologists), they opened up how the epidemic is not merely an isolated outbreak. It has roots not only in the civil war that devastated the nation over a decade ago, destroying 242 of the 290 health centers, but also in the policies that have resulted in the inadequate restoration.

The problem has not been lack of international investment in health in Liberia, Sierra Leone and Guinea, explained anthropologist Dr. China Scherz. Rather, money poured into projects and vertical pharmaceuticals, instead of building basic infrastructure and education, has not lead to sustainable solutions.

In the region where Dr. Hena works, for example, there were only three physicians for 200,000 people at the time the epidemic began. In July, clinics were closed, and nurses took it upon themselves to care for patients. Thirteen without access to proper PPE equipment died.

Meanwhile, ex-patriots and NGOs fled. While no one could fault them as individuals, the gaps they left at all levels of basic service delivery show the problems in failing to train capable local individuals.

At the moment, resources must be aimed to contain the unimaginable disaster and develop therapies. Drs. Frederick Hayden and Judith White explored the current therapeutic and prophylactic options under development, explaining the molecular basis for the Zmapp, siRNAs and experimental vaccines under development.

The panel left me reflecting on the conditions that allowed the Ebola epidemic to develop. As Dr. Christina Hena said, the national and international organizations should have known this would happen in a country with fragile health infrastructure. In March, when the first cases were reported, nobody did anything. March went by. Then April, and nobody did anything, except Ebola songs (http://www.youtube.com/watch?v=1_WOR22-SnY ) started coming out and people danced to them. Because they didn’t know what Ebola was, so they danced to the music.

Given the delayed response, absence of health care and witnessing horrific consequences of the disease, it is hardly surprising that the public do not trust those who come in the “space suits” to provide them aid. Rather than blaming people for eating bush meat or their funeral practices, perhaps the better question is what public health practices have led people to not trust those who come to help at this late hour.

I cannot help to think what the implications will be even in the best-case scenario. The few hospitals there are empty, many health workers have died, schools are out and the social fabric made up of handshakes, hugs and family closeness have dissolved. Chronic health conditions and mental health sequela of the epidemic are unlikely to be resolved in the short-term. These all lead us to question how public health is carried out and how such enormous disasters may be prevented.

For now though, the escalating emergency calls for the investment of health care resources. During the session, the question was posed as to when UVA can return to West Africa. Pethreree Norman, a Liberian nurse and student here at UVA, had a response. UVA does not have to leave West Africa, but can participate in the efforts through fundraising. She has already collected 1705 dollars and 2000 units of medical supplies to send to Liberia. Your donation will help alleviate shipping costs to the organization Aid for Ebola Liberia.

You can contribute at: http://www.gofundme.com/dm8ybk Now is the time to stop this epidemic from devastating the lives of the thousands it continues to kill, 40% of which have died in the last 21 days.

But at the same time as we contribute in solidarity, the panelists urge us not forget about Liberia, Sierra Leone and Guinea once Ebola is out of the news. The solutions of empowerment and capacity building they offered are relevant in all of global health. If we do not want a next disaster, we need to fix the way we do public health.

Report and Reflection: The 2nd UVa Global Health Case Competition

“5:30am,” replied the bleary eyed student.

It was Saturday morning and I had just asked her what time she had gone to bed the previous night. No, she hadn’t been partying it up on the corner—she and her interdisciplinary team had been polishing up their presentation for the second UVA Global Health Case Competition. The first iteration of this event in 2013 had challenged participants to present proposals to control the menace of extremely-drug-resistant tuberculosis and other health concerns in the slums of Mumbai, India. This year’s case was equally challenging: prioritize the health needs of Syrian refugees and develop a pilot program to address these needs in Syria’s neighboring countries.

Case Competition Flyer (courtesy: Manya Cherabuddi)

The case, written by a group of students from across the University and including members of last year’s winning team, objectively described several problems and complicating factors that the United Nations High Commissioner for Refugees is currently facing. About six million Syrians are internally displaced and another 2.5 million have been scattered across the middle-east and Europe as a result of the crisis, which many believe to be the most serious humanitarian crisis since the Rwandan genocide of 1994-1995. Syria’s health infrastructure has been reduced to rubble by the conflict, leaving Syrians with no preventative health services. Consequently, the recurrence of polio was unsurprising, but horrifying for a global community that has invested some much to eradicate this disease.

The case also focused significantly on social and health issues plaguing the women among the Syrian refugees. Not only are there insufficient obstetric and gynaecological services available to Syrian women in the refugee camps, they are also forced into an oppressive social dynamic. For instance, young Syrian girls are coerced to marry older local males in hopes of establishing economic security for their families. The danger of rape and molestation is ever-present in the tumult of large refugee camps. The case cited the example of women in the Za’atari camp who actually dehydrate themselves during the day to minimize toilet use as they fear lurking rapists. The case challenged students to propose a realistic initiative with a maximum budget of $25 million to ameliorate one or more identified issues in Syrian refugee populations.

One of the finalists explaining their vision

The students were given the case on Monday and had until Saturday morning to formulate their proposals. Some of the teams were pre-made and others were randomly created with students who had applied to participate in the competitions individually. All in all, we had fourteen teams with representatives from at least three different disciplines. Within a week, they researched the situation, identified the issues they were going to tackle, and designed an innovative intervention. From my participation in the 2012 Emory Global Health Case Competition in Atlanta, I know the incredibly hard work required to produce a presentable solution. My team members and I easily spent more than 30 hours individually to develop an appropriate health intervention for Sri Lanka. I saw teams put in equally hectic hours for our internal competition this year.

The product of their labours was commensurately incredible. I really enjoyed the detailed and diverse proposals on display. The proposed interventions ranged from cash transfers and social entrepreneurship grants in Lebanon to enhancing the educational facilities in Jordan. The winning team, Healthy Hoo’s, had students from the Frank Batten School of Leadership and Public Policy, the Curry School of Education, and the College and Graduate school of arts and sciences. They were notable for the wonderful way in which they interwove their innovative proposals with the narratives of individual Syrian refugees, reminding us of the mass of humanity at the root of this situation. The runners up, Power Rangers, were a team of RAs, who were impressive in the focus and detail of their proposed GIS surveillance system.

Our wonderful judges

Obviously, I didn’t engage with the case with anything close to the intensity that the teams displayed. However, I think I learned an important lesson from our incredible case writing team and dedicated contestants. A common and powerful theme in all the presentations was the importance of providing normalcy to the refugees. Medical education instils a strong predilection for pragmatism into students like me. This leads us to focus on things like diarrhea, obstetric complications, and vaccinations. The importance and cost-efficacy of interventions like these are above questions, but are they enough?

Before medical school, I fancied myself to be a biologist and often had to consider whether an element in a given molecular process was necessary, sufficient, or both. In this case, I believe that our pragmatic medical priorities are necessary, but not sufficient. Refugees are not just broken bodies to be fixed and mouths to be fed. They include children who dream of becoming astronauts, teachers with a passion to inspire generations, and carpenters who take pride in things they construct with their hands. Often-times we forget this and, years after their formation, refugee camps continue functioning in an emergency-mode, putting bandages on wounds but not charting a path back to normal life.

At the 2014 UVa Global Health Case Competition I realized that working with (and I mean WITH) the refugees to construct channels back to a productive and vibrant life, in which they can heal from the scars of conflict, is as legitimate a priority as giving them clean water and food.