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Public Health in the News – June 28, 2015

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Spotlight on Recent Research: The Long-Term Health Consequences of Bullying

By Mo McNulty

Bullying has long been recognized as a public health problem, with both victims of bullying as well as the bullies themselves experiencing health problems such as headaches and anxiety. Additionally, other studies show that bullying victims are more likely to consider suicide, and a large proportion of suicides among young people are likely linked to bullying. Now, a new study published in the BMJ has found that negative health effects caused by bullying persist for years; children who had encountered peer victimization experienced higher rates of depression as young adults.

Oxford researcher Lucy Bowes and her colleagues conducted a longitudinal observational study: they collected data on the same subjects over time. Their subjects came from the ALSPAC cohort, a group of British children who have been followed since before birth.

Bowes et al. interviewed children at the ages of 8, 10, and 13 to see how often they experienced different types of bullying. The researchers then followed up with a subset of the children five years later to determine how many experienced symptoms of depression. They found that children who were frequently victimized were more likely to be depressed at the age of 18. Furthermore, there was a dose-dependent association between bullying and depression: subjects who were bullied often were more likely to report depression than those who were only bullied occasionally.

Here’s a table showing the proportion and odds ratios of depressed teens, based on how frequently they were bullied. Their authors presented their data in both unadjusted form, as well as adjusted for various confounding factors:

Odds Ratios for Depression

The researchers also calculated the population attributable fraction, which is the amount that a given risk factor contributes to a disease. They found that 29.2% of the risk of young adult depression in their cohort could be explained by childhood bullying.

Because this was an observational trial, it was impossible for the researchers to directly determine whether the relationship between bullying and depression is causal. However, their evidence does support this notion. Additionally, the authors noted that there might be some bias in their study, as 18 year-olds from more wealthy, educated families were more likely to return to the clinic. Therefore, the sample of young adults that was tested for depression may have had different characteristics than the starting sample of children in which bullying was measured.

Although other studies have previously shown similar links between bullying and later mental health problems, this study is by far the biggest; as a result Bowes et al. were better able to adjust for some confounding factors that had limited previous studies. This study indicates that bullying prevention programs are an important public health intervention.

Bowes L, Joinson C, Wolke D, Lewis G. Peer victimisation during adolescence and its impact on depression in early adulthood: prospective cohort study in the United Kingdom. BMJ 350, h2469 (2015). PMID: 26037951


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Public Health in the News – June 21, 2015

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Building a Comprehensive Medical Records System to Improve Patient Health Outcomes

An interview with Dr. Abel Kho, Director of the recently launched Center for Health Information Partnerships (ChiP)Abel_headshotDr. Kho is a practicing physician at the Northwestern Medical Group and director of the new Center for Health Information Partnerships (CHiP) in the Institute for Public Health and Medicine at the Feinberg School of Medicine. Dr. Kho is also the principal investigator of Healthy Hearts in the Heartland, and co-executive director of the Chicago Health IT Regional Extension Center (CHITREC). His research includes creation of multi-institutional clinical data networks, health applications of geographic information systems, and data set-driven decision support.

NPHR: Tell us a bit about how you got to where you are?

Dr. Kho: I really debated whether to go to medical school and I only applied on time to one medical school. I always wanted to do something with technology. I remember while I was interviewing for my residency at the University of Michigan, the faculty member asked me, “What do you think are the two biggest innovations in health care?” And I said, “genetics and the rise of computing power”- and of course I did not get in – but I still believe that. If you look at where things are going, technology is not going to fade; it’s only going to be more and more ubiquitous and we have to do a better job and think of smarter ways to integrate technology to improve health care. Likewise we are only going to get more insight into how genetics affect our lives and health outcomes – it will happen.

How did you first get started in health informatics? 

Dr. Kho: During my chief year in Internal Medicine Residency I had a great mentor in Robert Schilling , (below with Dr.Kho) the inventor of the Schilling test for B12 deficiency and a hematologist. He and his colleague Dr. Warren Slack were professors at the University of Wisconsin – Madison where I did my residency. During my chief year I had a little bit of research time and started helping Dr. Schilling with this database that he created of all the known hereditary spherocytosis patients he had ever encountered. In exchange for working on this database, he would take me fly-fishing. So each time we went fly fishing he gave me some hand tied flies and we would have a beer and just talk about cases and career.

Dr. Kho and Dr. Robert SchillingDuring one of these sessions he told me if you are ever interested in really working on these kinds of database projects, I know this guy Clem McDonald, in Indianapolis, who is also interested in building electronic medical records, you should meet him. So I took time some time off and met Clem McDonald. He invited me to do a fellowship in informatics in Indianapolis but advised me that ultimately I should do what was best for me. During this same period, I had just finished transitioning the whole residency program to a fully online system for tracking schedules, so I realized I was starting to do more work on how to change systems to improve the way we deliver care. I had trained previously in theoretical and applied mechanics at the University of Illinois Urbana-Champaign College of Engineering before going to medical school. Coming from this background during my residency training I kept thinking, we can do these things better, and we can use technology to scale improvements up – not just for my patients but for a whole region. So at the end of my residency training I became interested in tools that allow us to scale up health care improvements. So as I moved to Indianapolis I started asking, “What are health care problems that can be fixed and scaled?” At this time I read the book “The Coming Plague” and one of the questions raised in the book is drug resistance. It led me to wonder: how do we track drug resistance? So we developed a database and alerting tools to track drug-resistant bacteria in our county hospital in Indianapolis. That project morphed and grew and now we track not only MRSA or VRE at one hospital but all major hospital systems in Indianapolis, and we also automatically track all the multidrug-resistant gram negative organisms too. That technology does not have to just exist there. Now that we have created it we want to make it available to any region, as our system is relatively portable. So we can pick up our system drop it on a local server – turn on a couple of data feeds to it and we will be able to track similar infections in this region.

How do you use technology to improve patient outcomes?

Our current approach is fairly straightforward – we start with a simple problem in health care and ask how can technologies make it more efficient and how scalable is it and then we try to solve that simple problem and scale up our solution. Another project we’ve been working on recently: a couple of years ago we got a grant to install electronic health records in Chicago (CHITREC) and at the time we had to fight resistance like, “what are you doing, this isn’t research!” Still, we believed this work was important and would help us develop a framework for capturing and better understanding health data. Over the course of this work we have developed wonderful relationships around Chicago in non-academic settings where we have installed electronic health records. These non-academic settings include all the federally qualified health centers in Chicago, and numerous small clinics scattered around the Chicago metro area. This preliminary work allowed us to successfully apply for a recent even larger grant to directly connect the data from all the local health centers around the Chicago area (about 250 clinics) to a central common node so we can start to first measure the baseline quality of care in a region and to assess the effect of clinical and population-based interventions on a region – all data collated from the interconnected network of local health centers. It took us 5 years to build the framework to ask research-relevant questions but now we have both the relationships and the resources to tackle research questions that will affect 3 states: Illinois, Wisconsin and Indiana.

What specific questions do you think this new infrastructure allows you answer?

Dr. Kho: Much of this work is at the interface between primary care and public health – a lot of the work we are doing depends on public health partners, because when you think broadly, informatics and public health are both broad system-wide approaches to solutions to problems. If we succeed we will be able to know whether data capture through routine primary care can effectively measure the health of certain populations by following and tracking the health of those populations through time and to determine if those interventions are working.

The question this approach raises is how representative of the general population is the sample captured by our electronic health records. So what we are trying to do in parallel is a validation study to determine how representative our medical records obtained data is of the general population. One validation is at the population level and the other is at the individual level. Great work done at the Alliance of Chicago has also been trying to validate these data at the individual level through interviews and public health surveys that are linked to electronic records data.

What are some challenges of managing a comprehensive medical records system?

Dr. Kho: As we have worked on this project a few challenges have emerged. And a major challenge for research based on electronic medical records is the question of unique patient identity – which comes up over and over again -particularly as we start doing work across multiple institutions. The reality is a person or people do not just interact with one health center, they interact with multiple health centers through time. The challenge becomes: how do you preserve the privacy of the individual, while preventing oversampling? So we had to design a novel approach that allowed us to do this in the past few years. This approach is now being employed by several institutions that are part of the Chicago Area Patient Centered Outcomes Research Network (CAPriCORN) (the PCORI-funded regional network of institutions that have agreed to form a clinical data network to conduct comparative effectiveness research). The long-term goal will be to integrate data from large institutional networks from groups like CAPRICORN to the data from smaller health centers from CHITREC to get a more comprehensive picture of the health of the region, and this can be used to track and measure health outcomes and intervention effectiveness. To help ensure we address any privacy concerns we are working closely with a health information privacy expert at Vanderbilt (Bradley Malin) for the past several years. He ensures the way we do our work minimizes the risk of identification and re-identification of participants. Fortunately he has been involved with writing the federal legislation on health privacy so he also ensures we are complying with federal regulations.

We are in a data age and everyone realizes the tremendous value that data has. But like all things of great value, folks that have it want to protect it and keep it for themselves. But greater value can be obtained from data when it is combined or compared with other data. To do this effectively you have to have appropriate stewardship, expertise and a human touch. So we believe the center is an opportunity to bring all the different components that make data powerful together, in a safe, secure, trusted and purposeful environment so that people can come up with and bring together their questions, methods, and data in a place where they can realize the greatest value from their data. This is important because a lot of the people who have the technical expertise don’t have access to the data and conversely a lot of the people generating valuable data don’t have the requisite tech savviness. We find that when it comes to data it is important to provide a safe stewardship environment that understands that people are dealing with something that is very valuable to them and need a relationship that provides clear value to all partners. This is a recurring theme in many of our projects.

What is the long-term goal of CHiP?

Dr. Kho: Our main goal through the center is to empower and enable a broader community than we currently have, to ask and answer their most pressing health questions. There is no upper bound to the types of questions community members might come up with. Personally, I would love to see work using these patient-based health records to result in true innovations in improving quality in clinical care. And I believe in time these resources will give us enough power to conduct certain types of analyses – particularly questions that relate to the influence of genes and environment on disease. A comprehensive, representative set of patient health records system over a diverse region like Chicago makes it more feasible to conduct studies like these.

What kinds of services are you able to offer at CHiP and what infrastructures do you have in place?

Methodology experts: we have domain experts that are important for health data projects. Privacy and security foremost. Big data analytics and folks who are really skilled at that. Epidemiologists and informatics folks who understand the key methods and also library and informatics folks who understand how to categorize and index data.

Database: We have already have built connections to extensive health records data through CAPRICORN and CHITREC and we are currently working on creating snapshots so people can get a better sense of the types of data we have as well as the geographic scope of that data especially as our data keeps expanding.

• Partners: We see an opportunity to engage industry partners; where we can’t or have not currently scaled a project, we can do so with industry partners. So what we are really hoping to engage are people, communities, methodologic experts, and data stewards as the framework of our services. Our goal is to create true partnerships that help our partners make the most of available data. We are starting off with three tracks to provide an anchor including one focused on gene-by-disease-by environment type studies.

As you look back at your career so far what lessons have stood out the most?

Dr. Kho: I think willingness to take a risk. One thing we try hard to instill in our team is the importance of taking risks and failing. A failure in one direction can be very empowering and can lead you in surprising directions. We’ve been lucky in that some risks have been really rewarding, but probability is also on your side if you fail enough times. It’s a wonderful confluence right now – it turns out that being an informatics person who is also a primary care provider is a really good thing right now and there are good funding opportunities for this type of research. I have never seen anyone succeed greatly by just following the path – it just does not happen – you have to be willing to take a risk and jump off the path.

Thanks for your time Dr. Kho.


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Public Health in the News – June 14, 2015

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Public Health in the News – June 7, 2015

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The FDA and drug shortages in remote clinics and surgical centers

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By Osefame Ewaleifoh (PhD/MPH candidate)

The problem of drug shortages remains a subtle but complex public health concern particularly for clinics in remote locations and surgical centers. Drug shortages stem from an intricate web of economic, legal, and clinical decisions that span from the need to tightly regulate the distribution of highly potent drugs to lack of infrastructure for delivering drugs to remote locations . Surgical center drug shortages  impact anesthesia and chemotherapy drugs most severely, creating problems for ambulatory surgery centers that depend heavily on these drugs for patient care. While seemingly inconsequential  drug shortages can have fatal consequences  as physicians find new substitutes for scarce drugs.

Unlike most players in the healthcare continuum,  the U.S Food and Drug Administration (FDA) is uniquely poised to lead a carefully orchestrated and multifaceted effort to manage the drug shortage crises – The sole objective of the FDA is to protect public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and 5275421991_c207c4a945_oproducts.The FDA is also responsible for coordinating federal responses to drug shortages. Thus with the growing challenge of drug shortages the pressure on the FDA has also grown . In response the FDA has taken on the herculean task of working with stakeholders such as drug manufacturers and suppliers to prevent and respond to drug shortages in surgical centers. The FDA’s working model to manage drug shortages is simple; learn about an impending drug shortage as early as possible and bring critical stakeholders like manufacturers and suppliers together to prevent or ameliorate such a potential shortage.

At the core of the push to track and prevent drug shortages is the Center for Drug Evaluation and Research (CDER) (2). The CDER tracks shortages in both prescription and over the counter medications . The CDER’s drug shortage program (DHP) receives notifications from manufacturers, Health care centers, surgical centers and wholesalers and validates this potential shortage information with manufacturers. Upon confirming shortage the CDER activates a series of tools and strategies to mitigate and limit the potential drug shortage. The FDA currently employs two main approaches to managing drug shortages; prevention of drug shortages and response to drug shortages (3) .

To prevent drug shortages the FDA has three main strategies; expediting the review and approval of new manufacturing sites and new suppliers, exercising regulatory flexibility and discretion and asking other firms to increase production. To respond to drug shortages the FDA has three main strategies; Asking other firms to increase production, expediting review of regulatory submissions and exercising regulatory discretion such as controlled importation of similar products approved abroad but not in the U.S. Other efforts by the FDA to curb the growing shortage of drugs in surgical centers include writing a letter to drug manufacturers reminding them of their current legal obligation to notify the FDA in advance of drug shortages and supporting legislation that requires early notification from manufacturers on impending drug shortages.drug supply chainThe role of the FDA as a facilitator, managing drug shortage is complicated by the lingering perception that the FDA itself is partly responsible for drug shortages because of its intense regulatory activities. Today most of the FDA’s operational powers with regards to managing drug shortages come from section 506c (4)of the FD&C act which requires the sole source manufacturer of certain drugs (life sustaining or intended for use in the prevention of debilitating disease) to notify the agency at least six months prior to the date of discontinuation of the manufacture of such a drug. However this act does not provide the FDA with any explicit enforcement authority, leaving it relatively impotent. In response to this impotence, a recent bill ( S. 296) proposed by senator Klobuchar expands the 6 month rule by requiring manufacturers of all drugs (not just life threatening drugs) to report all supply disruptions or product discontinuations that could lead to shortages six months in advance or as soon as practicable or face very stiff penalties (5).

On the executive level, the Obama administration, also recently signed an executive order directing the FDA to streamline the process of approving changes to production lines (6) . This streamlined process should make it easier for drug manufacturers to respond more rapidly to notifications by quickly ramping up production of drugs anticipated to be in short supply.While individually important, these measures by the government and FDA remain only a small part of a desperately needed multi faceted approach to stem the growing crises of drug shortages in surgical centers around the country.

While some progress has been made by the FDA, it is clear that the challenge of ending drug shortages is a very daunting task.  A look at the FDA’s public drug shortage inventory online shows that this challenge is not going away any time soon. Resolving drug shortages both  domestically and internationally will require the brilliance and ingenuity of young scientist, public health scholars and entrepreneurs who  can adapt emerging technologies and models to crack this intransigent public health conundrum.

References:

2. Center for Drug Evaluation and Research, Food and Drug Administration. Manual of Policies and Procedures (MAPP). Available at:
http://www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/ManualofPoliciesProcedures/ucm079936.pdf

3. A review of FDA’s approach to medical product shortages. Press release October 31, 2011. Available at http://www.fda.gov/DrugShortageReport

4. 21 U.S.C. 356c
5. Preserving Access to Life‐Saving Medications Act, S. 296, 112th Cong., 2011.

6.“Executive order–reducing prescription drug shortages”. Office of the press secretary, The white house October 31st 2011

7. FDA schematic on drug production and distribution to prevent shortage. http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm277626.htm


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Public Health in the News – May 31, 2015

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An evaluation of the Female Genital Mutilation (FGM) project and improvements through Microfinance

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By Nida Jafrani, Barsha Mishra, RJ Shea, Mary Sprouse, and

Katie Yonover

(See full project report here)

Utilizing a March 2014 health assessment, Northwestern Access to Health Project (NAHP) identified a need to address female genital mutilation (FGM) in Douentza, Mali. To accomplish its goals, NAHP partnered with the Near East Foundation (NEF), a local NGO in Mali, to help implement and carry out the project in September 2014. In 2014, the NAHP initiated two health interventions in Douentza, Mali. The first project, as discussed in the NAHP blog post “Promoting Public Health Through Music in Mali”, was the production of an educational music album to increase local residents’ knowledge of common diseases and available treatment options. The second project is an ongoing FGM abandonment intervention that aims to reduce the practice through microcredit and education. This blog post provides a discussion of the second project and contains proposals for continued success of the project.

IMG_0039FGM is a traditional practice that is deeply rooted in multiple communities among twenty-eight countries in Africa and additional countries in Asia and the Middle East. In Douentza, 75% of females have undergone some form of FGM. In Mali, that percentage increases to 89% of females. To reduce FGM throughout the world, most NGOs traditionally focus on educating communities about the harmful consequences of FGM. In other words, most organizations focus on reducing the demand for the practice through anti-FGM education.

Unlike typical FGM projects, NAHP’s second intervention took an entrepreneurial approach by addressing the economics of FGM and supporting FGM education and sensitization in Douentza. Because FGM provides financial benefits for the cutters, this project focused on reducing the supply of cutters through the creation of alternative livelihoods. With the help of the NAHP team in Mali including NEF and project manager Laya Ongoiba, NAHP learned that the traditional “cutters,” the women who perform FGM, would give up their livelihoods if they had the opportunity and tools to sustain an alternative career. In Douentza, FGM is a livelihood that is passed down from mother to daughter; therefore, if the mothers participating in the project cease the practice of FGM, the concern of new cutters entering the market is low.

IMG_0040The NAHP in Mali identified the cutters in the region and reasonable alternative careers that each woman wanted to pursue. Ten cutters participated in the project; nine chose “embouche” (sheep/goat raising) and one chose to sell ice cream in the local market. These careers should provide about the same amount of income each woman earned from her livelihood as a cutter.

Each woman participated in a FGM training, a small animal training, and swore on the Koran that she would comply with the terms of her contract. The contract includes a commitment to stop performing FGM and to educate women who seek their services about the dangers of FGM.

After these steps were completed, Ongoiba helped the women open accounts with a local, woman-owned and managed microfinance institution, NEF Nayral (“Nayral”). Through each account, the women received the start-up capital for their chosen alternative careers. The goal of the project is that the women will eventually become self-sustaining in their respective businesses.

IMG_0063In March 2015, our group evaluated the success of the FGM project since its implementation in September 2014. We qualitatively and quantitatively assessed the project’s effectiveness for reducing the practice of FGM in the region and we evaluated the sustainability of the microfinance aspect of the project. After completing the evaluation, we made proposals for improving the existing project in Douentza and scaling the project.

Project Manager Laya Ongoiba qualitatively evaluated the project based on her relationships with the traditional cutters and the Douentza communities. She concluded that community members are still approaching the cutters to perform FGM, but the traditional cutters refuse and educate those community members on the harmful effects of the practice (Ongoiba Report Sept. 2014). Local health officials including Doctor Yacouba, director of the Douentza Community Health Center (“CSCOM”) and Doctor Baboucar Traoré, Chief Doctor of the referral health center in Douentza, provided information about FGM-related complications and general attitudes about FGM in the community. Doctor Yacouba strongly believes that attitudes about FGM are slowly changing; however, he did not have conclusive data on FGM-related complications. Both doctors explained that the reason this data does not exist is because FGM is done in secret and families will not bring their child to see a doctor unless a complication becomes so severe that intervention is necessary. Doctor Baboucar Traoré and Doctor Yacouba emphasized the need for continued education on FGM in the community.

From this information we learned that while attitudes are changing about FGM, some members of the community continue to support the practice. For example, while the younger generation is generally open to change, older women are more resistant to change and often pressure younger women to carry on the tradition of FGM. In order to assure continued community buy-in for the project, attitudes towards cutting must shift so that the practice is no longer in demand.

To help support this shift, we proposed the implementation of a community education outreach plan. The outreach plan targets three specific groups: 1) older women, 2) men, and 3) young people. Ongoiba and each cutter in her respective village should meet with each of the three target groups to provide education and sensitization on FGM. These efforts should also include the support of community leaders like young advocates, local Imams and Village Chiefs. We believe that the proposed outreach plan coupled with the project’s current approach of targeting the supply of FGM in Douentza is necessary for long-term success of the project.

To ensure the project’s sustainability within Douentza, our evaluation of the microfinance aspect of the project illuminated two important areas for improvement: financial literacy and sheep/goat raising.

Financial literacy sets a foundation for the sustainability of the project. Financial illiteracy increases exposure to emergencies, theft and fiscal mismanagement. A major change that many of the cutters have experienced is learning how to smooth their income over a six-month period before selling each set of animals. In their old careers after each FGM, the cutters saw immediate monetary results. To address this challenge, we proposed the implementation of a small business training which would help improve financial literacy. Small business training would explain how much each woman should expect to make from selling her animals, how much money each woman needs to buy for the next batch of sheep/goats, how to manage profits, and how to begin saving.

Additionally, the cutters are new entrants into the field of sheep/goat raising. To ensure maximum efficiency in these new livelihoods, additional trainings on sheep raising should be incorporated into the project. Our research identified four areas of focus: 1) housing arrangements, 2) feeding techniques, 3) biosecurity, and 4) administrative practices. We determined that increased training in these areas could significantly increase the women’s effectiveness and productivity, which in turn increases the project’s sustainability.

Finally, if the project is scaled out to other communities within Mali, our team concluded that two of the most important variables that must be addressed from the onset are the demand for the practice and the importance of strong, local leadership. Although the project in Douentza began by focusing heavily on the supply-side of the practice, it may not be feasible in other communities to effectively cut off supply in the same way; for example, if those communities are better connected to larger cities. In addition, Laya Ongoiba has been a vital part of the health intervention in Douentza, and has been described as a key player in its successes. Therefore, locating a leader who is invested in the project and widely-respected in the community is a significant variable to consider when scaling the project horizontally to other communities in Mali and could considerably enhance its success.

References:
28 Too Many FGM…let’s end it. Country Profile: FGM in Mali. 2014. http://www.28toomany.org/media/uploads/mali_final.pdf (accessed March 21, 2015).

Guindo, Yacouba. 2015. Interview by NAHP team during March 2015 Site Visit. March 2015, Northwestern University School of Law.

Laya Ongoiba, e-mail message to Juliet Sorensen, December 23, 2014.

Laya Ongoiba, e-mail message to Juliet Sorensen, February 25, 2015.

Near East Foundation. 2010. Women’s Microfinance. http://www.neareast.org/projects/mali_microfinance (accessed February 2, 2015).

Sorensen, Juliet. Women’s e-News. Genital Mutilation. August 26, 2014.
http://womensenews.org/story/genital-mutilation/140825/curb-fgm-our-project-focuses-thecutters#. VACtt5Uo7GI (accessed March 1, 2015).

Traoré, Baboucar. 2015. Interview by NAHP team during March 2015 Site Visit. March 2015, Northwestern University School of Law.

WHO Progress Report, An update on WHO’s work on female genital mutilation (FGM). 2011.
UNDP, UNFPA, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO/RHR/11.18, http://whqlibdoc.who.int/hq/2011/who_rhr_11.18_eng.pdf (accessed March 21, 2015).

About the Contributors:
Katie Yonover: Katie Yonover is a third year law student at Northwestern University. Katie graduated from the University of Illinois with a B.A. in Global Studies and Spanish. She is particularly interested in international law and development. Katie had the opportunity to travel to Mali with the NAHP team in March 2015.

Mary Sprouse : Mary Sprouse is a second year law student in Northwestern University’s Accelerated JD program. She has a B.S. from Kansas State University in Mechanical Engineering, and she is interested in pursuing energy law after law school.

Nida Jafrani: Nida J received her J.D. from Northwestern in 2015. She has a B.A. in International Affairs from The George Washington University, and prior to law school she worked at the Carnegie Endowment for International Peace. She is excited to pursue a career in international law and will begin as an associate at White & Case, LLP in October.

R.J Shea: will enter his third year at Northwestern University’s School of Law in the Fall of 2015. R.J. graduated from the University of Wisconsin-Madison in 2012, earning a B.S. in Microbiology and English while maintaining a social life that would make Leonardo DiCaprio envious. R.J.’s legal interests include litigation, international human rights, and public service.


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Courtney and Chris Combe Give $1 Million to NU’s Access to Health Project

Northwestern University students and graduates will soon have even more opportunities to become engaged in global health and development, thanks to a generous donation to the Access to Health project. This program, a collaborative effort between the NU Law School, Feinberg School of Medicine, and the Kellogg School of Management, allows students and faculty to come together to develop and implement sustainable public health interventions in various international communities. Past efforts have included establishing an HIV course for clinicians in the Dominican Republic and producing songs that provided public health information to people in Mali.

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Now, a gift from Courtney and Chris Combe will provide support for the Access to Health Project:

As campaign co-chairs for We Will. The Campaign for Northwestern University, Courtney and Chris Combe are very familiar with the many ways philanthropy is working to help Northwestern students and faculty solve society’s most critical challenges.

In their official capacity, the Combes joined the Law School community to celebrate the launch of Motion to Lead: The Campaign for Northwestern Law. They were struck by the Law School’s commitment to social justice initiatives, in the United States as well as around the world. They decided to make a gift that would enable the Law School to expand programming in an area they are deeply committed to: international public service and justice.

In addition to providing funds for Access to Health, the gift will also establish two fellowships:

Clinical Fellowship within the Access to Health Project

Northwestern University School of Law invites applications for the Michael and Mary Schuette Clinical Fellowship in Health and Human Rights, beginning in mid-August 2012 in the Bluhm Legal Clinic’s Center for International Human Rights, with a particular focus on the work of the Northwestern Access to Health Project.  The Michael and Mary Schuette Fellow will have a unique opportunity to gain extensive training and experience in global health, human rights law and economic development, as well as clinical legal teaching.

The Schuette Fellow will work on issues related to global health, human rights and development as they pertain to ongoing community global health work in Mali, the Dominican Republic, the Democratic Republic of the Congo and Sudan, as well as other potential sites.  A demonstrated interest in global health law and fluency in French and/or Spanish is preferred. Applicants should send letters of interest and resumes to Juliet Sorensen, Clinical Associate Professor of Law, Center for International Human Rights (j-sorensen@law.northwestern.edu).  The deadline for applications is July 16, 2015.

International Field Work Scholarship for NU Law Graduates

Applications are now available for the Michael and Mary Schuette Global Fellowship in Health and Human Rights.  This year, a fellowship will be awarded to a current JD or LLM student from the Class of 2015 to work in the field with an international NGO on global health, human rights and development issues.  The fellowship will provide the recipient with a $70,000 package for a one year position beginning in September 2015, including salary, benefits and travel expenses. For the inaugural year of the fellowship, the placement with the NGO will be arranged by Northwestern Law School.

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