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Public Health in the News: May 8, 2016

Global

National

Illinois/Chicago

Northwestern

Brian Cheng, B.A. Student at Northwestern University 
Blog Manager


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NPHR Public Health News May 1st 2016

Original Title: Aa_FC2_23a.jpg

Image: Courtesy James Gethany   (CC)

Global News

Local News

  • Free timed races coming soon. Whereas timed races in the city have traditionally cost $50.00 a person, this summer, runners won’t have to sweat paying to lace up for a series of new runs at three Chicago neighborhood parks.
  • The Illinois Department of Public health this week confirmed the tenth case of Zika virus in Illinois.
  • A recent study  by Professor Ruchi Gupta of Northwestern published this week in Pediatrics found that food-allergic children from households that earn less than $50,000 a year incur 2.5 times the cost of emergency room visits and hospital stays compared with their peers from families that are in a higher-income bracket.

By Osefame Ewaleifoh


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The Role of Biomedical Visualization in Medicine and Health

By John Daugherty, Program Director for BVIS at UIC

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Cover art for the Spring 2016 Print Edition of the NPHR. 2015 © Wai-Man Chan (UIC Biomedical Visualization graduate student)

Visual Communication for Public Health

Healthcare providers, patients and their families, the public, the media, governments, and non-government organizations all need to be able to converse during a public health threat, but these diverse groups do not necessarily “speak the same language.” A good translator mediates between speakers of different languages, and biomedical visualization specialists can use visualization as a common language to help bridge the gap. A picture is a universal language that transcends not only every cultural boundary but also every conceptual boundary.

In response to reports of Ebola hemorrhagic fever in West Africa in 2014, the Centers for Disease Control and Prevention (CDC) fully participated in an international response to the outbreak. This included educating the general public in the nations of Guinea, Sierra Leone, Liberia, and Nigeria about how to avoid Ebola infection; educating healthcare workers about taking the steps necessary to protect themselves and prevent the spread of the virus; and improving communications between everyone involved [1].

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Figure 1. Poster for Sierra Leone rural population. 2014 © CDC/Dan J. Higgins (2000 UIC Biomedical Visualization graduate)

Visual information specialist Dan J. Higgins, Division of Communication Services for the CDC, was called upon to assist emergency response officials in Sierra Leone. There was a need for posters and handouts showing small care facilities that had been established in local communities, so people could get treated as quickly as possible. Community Care Centers (CCC) had been set up to provide suspected Ebola patients with food, water, oral rehydration solution, antipyretics and analgesics while undergoing tests for Ebola virus disease. Patients who tested positive for the virus were transferred to larger Ebola Treatment Centers [2].

Higgins created a poster depicting a typical CCC unit (Fig. 1). This simple, isometric perspective view of the camp is accurate, yet simple and straightforward. It was created in a hand-done style using bright colors to be easily read by the Sierra Leone rural population (D. Higgins, personal communication, June 3, 2015).

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Figure 2. Illustration for emergency response healthcare workers. 2014 © CDC/Dan J. Higgins (2000 UIC Biomedical Visualization graduate)

The same view of the CCC unit was re-colored and repurposed for healthcare workers (Fig. 2). Camps are divided into red zones and green zones, and the way traffic flows within the camp is very important. The light red zone is where patients enter and are housed while being treated. The darker red zone is for patients who are extremely sick. Healthcare workers in full personal protective equipment (PPE) enter the light red zone through the gate behind the blue building and are required to travel through the “less sick” section to the dark red, “more sick” section. The green zone is where staff work and rest and where the healthcare workers don their PPE and dry them (D. Higgins, personal communication, June 3, 2015).

Biomedical Visualization

Biomedical visualization is a multidisciplinary field that draws upon and integrates subject matter from a variety of disciplines including the life sciences, learning science, medicine, graphic arts, computer animation, immersive multimedia, and computer science. Biomedical visualization specialists use compelling and effective visual language to take complex data and abstract ideas and make them easily understood and tangible.

Information sharing among public health professionals and between those professionals and the public is critical to meeting the health needs of individuals and populations. Key stakeholders in public health may not “speak the same language,” but meaningful conversation can occur with the help of skillful biomedical visualization specialists, who are able to translate complex biomedical information into a visual story that explains and teaches.

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Figure 3. Editorial illustration for The Synergy of Public Health and International Criminal Law in Post-Genocide Rwanda. 2015 © Christine Cote (current UIC Biomedical Visualization graduate student)

While didactic medical illustration is used to teach, the power of editorial medical illustration lies in the way it uses visual imagery, and sometimes visual metaphor, to engage the reader and guide understanding. Editorial illustrations used to support an article in a public health publication can take complex concepts and make them accessible. Captivating images can be used to either illuminate subtleties in the text or boldly reinforce one or more of the main concepts in an article accompanied by the illustration. A medical illustrator is able to extract the “essence” of the text and give the article a visual personality.

Using Figure 3 as an example, the illustrator adopts the symbol of Lady Justice to provide context for an article on international criminal law, public health and Rwanda. Traditionally, Lady Justice is depicted with a set of scales representing truth and fairness positioned above a sword representing the power held by those rendering decisions. Here the illustrator uses the sword to represent the crimes of genocide in Rwanda, which is shown as a flag in the shape of the country. Lady Justice, who grasps a set of scales representing a mechanism for the world’s restorative justice, is embracing Rwanda. The illustration provides a visual summary of the article, but it also evokes feelings of tenderness and compassion, establishing an appropriate tone for the discourse.

Biomedical Visualization at UIC

Founded in 1921 by Professor Thomas Smith Jones, the Biomedical Visualization graduate program (BVIS) at the University of Illinois at Chicago (UIC) is one of only four accredited graduate programs in North America providing professional training for careers in the visual communication of life science, medicine, and healthcare. The program’s unique curriculum attracts graduate students from a variety of disciplines such as medicine, life science, art, digital animation, and computer science.

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UIC East Campus. Credit: Onar Vikingstad

BVIS utilizes the academic resources of multiple departments throughout the UIC campus to support its interdisciplinary studies. A recently revised curriculum strongly emphasizes effective communication and problem solving and provides a solid foundation in medical science, learning theory, and innovative visualization techniques. In addition to illustration and design, course offerings in visualization technology have been expanded to include animation, interactive media, educational gaming, virtual reality, stereography, haptics, and augmented reality.

Close relationships between UIC BVIS and other prestigious Chicago universities and medical centers provide opportunities for student immersion experiences and effective collaboration with peers. For the second consecutive year, BVIS students have had the privilege of contributing editorial illustrations for public health to the Northwestern Public Health Review.

Visual Translators for the 21st Century

We are in the age of visualization. The accessibility of biomedical visualization via mobile devices and other visual displays has made its delivery revolutionary. As part of the healthcare team, biomedical visualization specialists embrace their role as visual translators for the 21st century, leveraging their scientific knowledge and artistic skills to convey complex information for the benefit of everyone in the medical and public health system.

References

1. Centers for Disease Control and Prevention (n.d.). Retrieved from http://www.cdc.gov/ vhf/ebola/outbreaks/2014-west-africa/index.html

2. Plan International (n.d.). Retrieved from https://plan-international.org/about-plan/ resources/news/how-ebola-community-care-units-are-helping-to-stop-the-spread-ofebola/

This article was originally published in the Spring 2016 print edition of the Northwestern Public Health Review. Find other articles from the issue here!


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Public Health in the News – April 24, 2016

Global

  • The Pan-American Health Organization is implementing many emergency relief measures to help build up public health infrastructure in Ecuador following the recent earthquake.
  • Vox has a good explainer of the concept of “R naught” – a number used by public health officials to estimate how many other people are likely to be infected by a sick person.
  • Nearly two-thirds of the world’s unvaccinated children live in conflict areas, says UNICEF.

National

  • What if your therapist wrote a book, and you recognized yourself as one of the psychological cases inside? A psychotherapist talks about betraying his patients’ trust.
  • A recent study looking for “genetic superheroes” who have a certain gene mutation, but not the matching disease, has been widely reported. But this study has one big caveat – researchers couldn’t contact most of the individuals they identified as being resilient because of lack of consent forms.
  • A lot of data from cancer research can’t be reproduced, but there are measures we can take to help this issue.

Illinois/Chicago

  • A mysterious bacterial infection is popping up in Illinois, and has so far resulted in 6 deaths.
  • Would a merger between two large Chicago-area healthcare providers provide consumers with lower healthcare costs or reduce competition in the market? An FTC case against the merger provides an insight into the state of the region’s health systems.

Northwestern

Maureen McNulty, PhD Student at Northwestern University 
Blog Manager


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Finding The First Step: On Seeing Through the Lens of Students, Surprising Finds, and Finding a Way Forward Together

By Anna Maitland, J.D., Schuette Clinical Fellow in Health and Human Rights

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Access to Health students and faculty sit with the Federation Health Board to discuss findings about health issues in partner communities.

“How do you know if you have malaria?” “How often do people get burned in the community?” “How do you get clean water?”

The students lean in, their faces a study of interest, curiosity, and sunburn as they work to decipher the thick Nigerian English of the Health Team of the Nigerian Slum/Informal Settlement Federation, Lagos Chapter. The medical student has been taking copious notes – the diligence of his recordkeeping is later reflected in his report. One of the law students asks a question that she has made sure to ask across all focus groups – “Do women go for malaria testing or treatment when pregnant?” – which leads into a nuanced discussion of the interrelationship between infectious disease and maternal health in Nigeria. The business students keep clear records on perceived and real costs of supposedly free services, pointing out in post-meeting discussions the discrepancies and unpredictable costs of urgent care.

The Nigerian Slum/Informal Settlement Federation is a movement of the urban poor for dignity and development, made up of savings groups in informal settlements and slums in Lagos, Port Harcourt, and rapidly growing to other urban centers in Nigeria. The Federation’s Health Team – about 20 men and women from over 15 different Lagos informal settlements and at least 4 different language/ethnic groups, reflecting Lagos’s tremendous diversity – is fully invested, providing insightful answers while also asking pointed questions that show how hungry people are for information about their health. “Is it true that you can do family planning based on a woman’s flow?” “How do we stop measles?” “Why do I need to get a malaria test when I have the fever, aches, and sickness already?” “Vaccinations are dangerous and can kill us – why would we get them?”

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New friends from Northwestern, Federation, and JEI proudly show off their T-Shirt schwag

The Federation organizes communities through community-level economic empowerment, community-led data collection through participatory slum profiling and mapping, and strong inter-community solidarity and advocacy around shared challenges and priorities. This movement is supported by Justice & Empowerment Initiatives (JEI), a Nigerian NGO I co-founded with colleagues Megan Chapman and Andrew Maki in 2014, which provides grassroots legal empowerment to Federation member communities by training and supervising a network of community-based paralegals, providing free legal services and supporting community-led advocacy. During my years with JEI in Nigeria, I had spent a great deal of time with community leadership, women’s groups, savings groups and other stakeholders working on key community priorities such as stopping forced evictions, addressing police brutality, and helping communities access basic services such as water and electricity. However, while we at JEI understood that our partner communities face major health challenges – working to respond to and record the issues experienced by evicted communities, we had seen the brutal health consequences and deaths caused by displacement in already fragile health environments – responding to such challenges had never been possible as we lacked meaningful partnerships with health advocates. Thus, while I had a sense that health education was low, reliance on traditional medicine high, and access to hospitals was sporadic at best, deeply understanding and tackling these issues had never before been a focus.

In July of last year, I transitioned from Nigeria to Chicago for the inaugural Schuette Clinical Fellowship in Health and Human Rights at Northwestern Pritzker School of Law. The fellowship offered a unique opportunity to learn more about legal protections for health while supporting the work of the Access to Health Project (ATH). Co-founded by Prof. Juliet Sorensen and Dr. Shannon Galvin, ATH is an inter-disciplinary clinical program focusing on global health that was born from the realization that universities must help prepare students to become global citizens. Bringing together law students, business students and medical students, ATH partners with local NGOs and health-poor communities to research and together generate realistic, targeted, and innovative ways to address barriers to health.

From creative radio and alternative employment strategies in the struggle to stop female genital cutting in Mali, to conducting feasibility studies to help a resource-poor clinic stay open in Sudan, and working with health care providers in the Dominican Republic to form a coalition to streamline and enhance outreach efforts to bateys (neighborhoods made up predominantly of the Haitian-descendent minority), ATH has an impressive track record. From the moment I applied for the Schuette Fellowship, I hoped that ATH would be able to partner with and serve as a resource for Lagos communities.

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Bimbo Oshobe of the Federation explains why Access to Health is visiting, and asks people to share their stories.

And here I was, seven months later, in Lagos with ATH – Prof. Sorensen, Dr. Galvin, three law students, two business students, and a fourth year medical student – sitting in the JEI/Federation offices, talking to the newly constituted Health Team, and realizing with a shock just how little I had known about partner communities’ health issues. This was the last day of our trip, and I had learned a lot during our week in Lagos thanks to the inquisitive students and engaged community focus groups. Always game for what the day would bring, the students and professors had been enthusiastic, intrepid, and curious through 10-hour days in 90-degree weather, adjusting to the intense traffic and sometimes harrowing transportation of the largest city in sub-Saharan Africa (~23 million people).

Community members had been far more open in responding to sometimes deeply personal questions relating to HIV/AIDs, family planning, water/sanitation, fire safety, and diseases like malaria and measles than I had expected. I was even more amazed by the sheer number of people who made themselves available to discuss health issues, which spoke to the depth of their concern and interest in finding solutions. In the space of just six days, our team visited 10 different communities, engaged with at least 300 people through focus groups on different topics, and even found time to meet with the Lagos State Ministry of Health, the Provost of the College of Medicine at the University of Lagos, several health-related NGOs and doctors, traditional birthing attendants, and other health services providers. I felt an overwhelming gratitude and sense of honor to the number of people who had invited us into their communities, their homes, their lives, and their personal stories.

As the week had progressed, the focus groups had more and more often turned into basic health training sessions, with the health questions asked by the community conveying more than the answers to the questions we had asked. Watching as interviewees turned the meetings into a chance for them to get what they needed reminded me, again, of how resilient Lagosians must be to survive in this environment.

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Women from Otodo Gbame – a community that recently lost over 35 children to measles – get ready to discuss health and the things that prevent them from accessing health care.

We learned through these conversations that communities already understood that the extremely poor sanitation available in communities built on trash, with toilets hanging over the lagoon and limited access to clean drinking water and electricity, was directly related to their poor health outcomes. However, they struggle to find tenable solutions in the face of government threats of eviction, marginalization, and absence of most public services. It quickly became clear that hidden costs, fake medicines, and wrongly diagnosed illnesses were doing as much to harm access to health care as poor infrastructure, low education rates, and discriminatory doctoring. And, while I was not surprised by community member’s mix of correct and incorrect knowledge (yes, some people believe malaria is brought on by the sun, but they also know it is brought by mosquitos and that nets would be a good idea), I was unprepared for some of the misconceptions (e.g. HIV/AIDs could be transmitted with a hair comb or by mosquitos) and the general bias against formal medicine (e.g. vaccines kill children).

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After a long morning discussing HIV/AIDs transmission, family planning, fire, sanitation and infectious disease, we prepare to go tour local pharmacies in Tarkwa bay.

As I listened, I expected everyone – students, professors, Federation members, JEI – to become discouraged, to see these seemingly insurmountable odds and wonder how to even begin. After my time with JEI, I knew that sometimes you just have to start – take one thing, start working and then take on another, taking strength from small successes along the way. However, addressing barriers to health seemed different from the other work I had supported, with more dire and immediate consequences. And for a moment, sitting and discussing the week’s outcomes, I felt overwhelmed, angered, frustrated, and deeply saddened.

Then, one of the members of the Federation’s health team stood up and asked a question about family planning and another member stood up and gave an answer they had learned during one of the focus group sessions earlier that week. Another person began talking about how better toilets could change things for their community – make it more formal, cleaner, healthier – and I remembered the ATH student who had researched water/sanitation asking focused questions about this issue all week long. And I saw a starting place – one that would take time to grow and mold, but the beginning of a series of new community-owned processes around education, development, and empowerment. A step supported by students learning the meaning of global citizenship, a University invested in global health, and an NGO and Federation ready to make it happen. And I knew this had been a successful week.

 


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Public Health in the News- April 17th, 2016

Global 

  • Will yellow fever gain a foothold in Asia? “… if it does it would be a public-health disaster,” says an expert on mosquito-borne diseases at Duke-NUS Medical School in Singapore.
  • Starting today, 155 countries around the world will switch to a new polio vaccine in an attempt to make polio the second human disease eradicated.
  • Is a water shortage in our not too distant future? Recent studies reveal a startling conclusion– by the year 2050, half of the world’s population may be facing what scientists are calling a “high risk of severe water stress.”

National

  • CRISPR-Cas9 genomic editing: from bench to supermarket shelves. The USDA will not regulate a mushroom genetically modified with CRISPR to resist browning.
  • The quest to uncover novel compounds intended to prevent and treat Alzheimer’s disease is an increasingly pressing public heath concern. A recent NOVA documentary provides a glimpse inside the lives of both patients and caregiver’s.
  • Porn- a private matter or a public health crisis? Scientists take a health-focused view of porn illustrating that “exposure to and consumption of porn threaten the social, emotional and physical health of individuals, families and communities.”

Chicago/Illinois

  • Mayor Emanuel announces plans to work with Covenant House International to expand shelter for homeless youth in Chicago.
  • A water-testing program will be re-instated as a proactive measure to protect the health and safety of Chicago residents.

Northwestern 

  • As of Fall Quarter 2016, Counseling and Psychological Services (CAPS) will be lifting its current 12-session limit.
  • Northwestern researchers have developed a tool to protect coral reefs around the world from climate change
Caitlin Pegg, PhD Student at Northwestern University 
Blog Manager


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Psychiatric Disorders and Prison Populations: An Interview with Dr. Linda Teplin

By Maureen McNulty, PhD Candidate

What happens to people with mental illnesses who end up on the street?

“Here’s a typical case: The police picked up a guy who seemed to have schizophrenia and was also intoxicated. So, we took him to the hospital. The hospital, recognizing the man from prior visits, said ‘We don’t want this guy. He’s not really mentally ill, he’s just an alcoholic.’ So we got back in the squad car and took him to detox. The man had been to detox many times—he went straight to a bed, laid down, and took off his shoes. But the folks who ran detox said, ‘We don’t want this guy. He’s not just an alcoholic, he has schizophrenia. We can’t keep him.’ And so the poor man was arrested—not because he had done anything wrong—but because there was no other place for him except jail.”

The above is a real life account by Dr. Linda Teplin, Professor of Psychiatry and Behavioral Sciences at Northwestern and Director of the Health Disparities and Public Policy Program. She is a public health researcher with a history of studying stigmatized populations, and is currently leading The Northwestern Juvenile Project, which continuously tracks and interviews nearly 2000 youths who were previously arrested and detained.

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Dr. Linda Teplin

Dr. Teplin was recently interviewed for the NPHR by Dietta Chihade, a graduate student in Neurobiology at Northwestern. They talked about Dr. Teplin’s past and current research interests (“I specialize in studying people who fall through the cracks of the mental health and criminal justice systems”), career options for women in the 60’s and 70’s (“The medical school back then was a challenging environment. The washrooms at Weiboldt were labelled ‘faculty’ and ‘ladies.’ I never could figure out which one was the most appropriate for me”), and the intersection between mental health and incarcerated populations. These populations are particularly important to focus on, because, as Dr. Teplin points out, very few public health researchers work with them:

“[W]e have this gap: criminologists study correctional populations, but do not study health. And public health researchers avoid correctional populations. So my group has focused on studying people who fall between the cracks of the disciplines.”

Dr. Teplin first became interested in this area of research because she observed that very few psychiatric patients were being brought to Chicago emergency rooms by police. She wondered what was happening to the remaining people struggling with mental health issues who were undoubtedly on the street, interacting with police.

“My serendipitous observation led me to develop an unusual study. We rode with police during all hours of the day and night to see how they managed people with severe psychiatric disorders on the street. We wondered whether because of deinstitutionalization—and the overall paucity of mental health services— people with severe psychiatric disorders were ending up in jail.”

This resulted in the first large-scale study to look at what happened when police interacted with people with mental disorders. Their results showed that people with mental disorders were more likely to be arrested than those without, even when committing the same types of offenses.

“[This study] established that people with severe mental disorders were disproportionately arrested as a consequence of deinstitutionalization. And, they were arrested not because they were particularly violent, but because the proper infrastructure [like] proper housing, social services, [and] outpatient treatment was never established.”

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2015 ©  Sophia Dagnello (Current UIC Biomedical Visualization graduate student)

So now that Dr. Teplin and her team knew that the mentally ill were more likely to be arrested, they figured that looking at what happened to people who were in jail was “the next logical step.”

“Since then, we’ve studied men in jail, women in jail, and kids in detention. Our studies are unusual. Many public health researchers study patients. Or they collect data using household-based samples. Or they sample from school populations. But very few people study incarcerated populations.”

More research in this area is essential, since – as NPHR has previously discussed – huge numbers of people in prison are mentally ill, yet very few jails are equipped to meet prisoners’ mental health needs.

Dr. Teplin’s ongoing research, in which her team continues to track youths once they’ve left jail, has uncovered many new things about stigmatized populations. For example, one study smashed the stereotype that African-American youth were more likely to use hard drugs than were white youth: Caucasians who had previously been detained were 30 times more likely to use cocaine. Dr. Teplin has also found that most psychiatric disorders don’t predict the likelihood of someone having violent behavior in the future, and that youths who had been in detention centers were more likely to die violent deaths. Now, she is working with study participants to examine how incarceration is linked to drug use and HIV/AIDS risk behaviors.

So why is public health research with incarcerated populations so uncommon? Dr. Teplin says:

“I think it’s because many public health researchers are intimidated by the idea. They don’t know how to obtain access to study jails and prisons. They don’t know how to collaborate with correctional staff.”

So then what is the secret to doing public health research with people in prison? According to Dr. Teplin:

“Researchers need to think of ways to give back to the institution that they are studying. When we attempt to gain access I will meet with the people involved—it might be the presiding judge of the juvenile court or the director of the Cook County jail— and I will explain, in very straightforward terms, what our research is about, and why it’s important. We present the larger public health context…. Also, we try to provide a product for them that helps their work. So, we often say to people who run the institution, ‘We are going to be doing this research paid for by the Feds. What can we build in that would be useful for you?’ “

Finally, Dr. Teplin offers some advice for those wanting to do public health research as a career:

“My advice to people is to be well trained methodologically. Then you can pick up any content area. I’ve not been trained in the dependent variables we study, but I understand qualitative and quantitative methods. Also, it helps to be savvy. To be pleasant. To be bold. To choose a methodological approach that best fits the question, rather than the one that you are most comfortable with. To pick brilliant colleagues like mine (Professors Karen Abram and Leah Welty). And finally, to have the perseverance of a Jack Russell terrier.”

To read the full interview with Dr. Teplin, led by Dietta Chihade and found in our Spring 2016 print edition, click here. And check out other articles from the issue here!


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Public Health in the News – April 10, 2016

Global

National

Illinois/Chicago

Northwestern

Brian Cheng, B.A. Student at Northwestern University 
Blog Manager


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Access to Health in Lagos, Nigeria: A Health and Human Rights Assessment

By Farzeen Tariq, JD Candidate at Northwestern Law 

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Northwestern Access to Health 2016 team with JEI’s health board members

The interdisciplinary Northwestern Access to Health Project recently returned from eight days of fieldwork in Lagos, Nigeria, conducting a health and human rights needs assessment in collaboration with the Justice and Empowerment Initiative (JEI), Access to Health’s partner organization. JEI is a Nigerian non-profit focused on promoting social and economic rights through the training and support of community paralegals, provision of pro-bono legal services, facilitation of community organizing, and support for a growing Nigerian Slum/Informal Settlement Federation. The Federation is made up of over 70 different slum and informal settlements across Lagos, from which the Federation identified a Health Board to work closely with our Access to Health team to troubleshoot health issues in the informal settlements.

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JEI’s monthly meeting with the paralegals

Our interdisciplinary team consisted of M.B.A, M.D, and J.D. students, Professors Shannon Galvin (Feinberg) and Juliet Sorensen (Pritzker Law), and Anna Maitland, Pritzker Law’s Schuette Clinical Fellow in Health and Human Rights. The focus of the assessment was on malaria, fire safety, maternal health, HIV/AIDS, and water and sanitation.

The assessment included communities, such as Oko Agbun, that are established primarily on stilts above sewage water. As we canoed through the water to reach our first meeting, we saw open defecation and waste disposal around us. A number of the partner communities are built on swamps, have no sewage system and thus use hanging toilets and open defecation, which leads to polluted water ways and illness from flooding, as well as lack of safe drinking water. Such environments are also a breeding ground for malaria and other water-borne diseases.

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We canoed to reach the Oko Agbun community for meetings and residential assessments.

After observing the apparent open defecation and lack of clean water, we inquired about other existing infrastructure in the informal settlements, such as pharmacies, doctors, nurses, and access to health centers. The communities had limited medication available at “chemist’s shops” and did not have any pharmacies. Most community members resorted to herbal medication, and did not comply with dosage requirements for medications. For example, most people took herbs for illnesses such as malaria, and when they took an antibiotic/quinine to treat malaria, they stopped taking it as their symptoms got better.

Delivery rooms had no medical supplies or anesthetics. The communities lacked basic infrastructure, such as electricity, clean water, and even physical space.

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A delivery room in Oko Agbun.

Access to medical professionals is limited and sometimes impossible. For example, in communities such as Tarkwa Bay, a hospital is a 20 minute boat ride and an hour long car ride away. Most people did not own boats. Hence, a woman in labor could bleed to death before she could reach the hospital. Finally, the general level of health literacy was low. For example, there was a lack of knowledge about transmission, prevention, testing, and treatment of malaria and HIV/AIDS. However, majority of the community members were very eager for health education. As a continuation of our project, we will develop health education plans and a ground up, sustainable, capacity-building intervention, where communities will use their existing infrastructure to address their health issues and we will serve as a liaison between them and their goals.

We made many friends, such as Bimbo Oshobe, whose perseverance inspired us. Bimbo is a leader of the Federation and works closely with JEI. She was formerly a resident of Badia East, the community which was partially demolished first in February 2013 and again in December of 2015, and continues to be the subject of a World Bank safeguards process as a result of these forced evictions. She currently is staying over two hours away from Lagos near Badagry, and had to travel over 4 hours each day in public transport to help us with our fieldwork each day. On some nights she got home only to take care of her son, cook some small food, and turn around and get back on transport to come and meet us. We met paralegals like Samuel, Baba, and Sani Mohammed, who were adamant about transforming the conditions of their communities. Everyone welcomed us with warm arms and provided us with authentic information about the health issues of their communities and insights on the existing health infrastructure available to the country’s forgotten majority.

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Access to Health team with the Federation Health Board

In the words of Dr. Sade Ogunsola, the Provost of Lagos University Teaching Hospital, “there is order in disorder” in Lagos. We left Nigeria with the scrumptious scents of Jollof rice and suya, the mischievous glint in Bimbo’s son’s eyes as he ran around taking selfies on our phones, the can-do determination that Bimbo gracefully exuded, the witty ways Samuel and Rasheed joked with us, the government’s ignorance, the forgotten majority’s perseverance and optimism, and the watchwords of the Federation: Information = Power; and Unity = Our Strength.

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Contextual map of central Africa- Lagos, Nigeria highlighted. (courtesy of CC)

edited by Caitlin Pegg, NPHR blog manager

 


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Public Health in the News – April 3, 2016

Global

National

  • The soon to be largest ever study of transgender teenagers- findings could help clinicians to judge how best to help adolescents who are seeking a transition.
  • There’s something in the water… Concerns about water safety aren’t just on the minds of Flint, Michigan residents anymore. Elevated levels of a suspected carcinogen have been found in the water supply of several Northeastern states. “This is not just a local problem. This is a problem which I am sure occurs in every single state,” states Philippe Grandjean, a professor of environmental health at the Harvard School of Public Health.

Chicago/Illinois

Northwestern 

  • Combating the antibiotic resistance crisis- Northwestern Medicine Investigator reports behavioral interventions that aid in reducing antibiotic overuse.
  • April is Sexual Assault Awareness and prevention Month (SAAM): Northwestern University partners with student groups to raise awareness about sexual violence and to help educate the Northwestern community on how to prevent it.
Caitlin Pegg, PhD Student at Northwestern University 
Blog Manager
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