Although the school has been involved in global health research and education programs for students for many years, the new center coordinates current educational efforts, provides more robust research opportunities, and moves Northwestern into a larger arena.

In his recent State of the School address, Dean J. Larry Jameson described his goal to move the school’s ranking to the top 10 of medical schools in the United States by 2020. Those premier academic institutions all have programs in global health. “Northwestern must go global if it is to become a major American university medical school,” says Dr. Murphy. That’s where his plan comes into play.

Five years from now, he envisions a center that will be a substantial globally oriented enterprise with active research and teaching components, including exchanges among Northwestern faculty, partner faculty, and students. Additional faculty members and an increase in the number of grants and philanthropic support will anchor the center. Add to that further development of relationships with partners in Africa and expansion to an Asian site. In Europe, he sees the medical school partnering with select universities, formalizing relationships with them, and establishing a Northwestern office in a major European capital, probably Paris.

Dr. Murphy, an internationally regarded infectious diseases physician, scientist, and educator, began his tenure at the medical school in 1981 and became John Philip Phair Professor of Infectious Diseases in 2001. He founded the International AIDS Education Project in the mid-1990s and continues as its director. In 2003 he was appointed Nigeria country director for the President’s Emergency Plan for AIDS Relief (PEPFAR), and in 2008 received the first of two Fogarty International Research Collaboration Awards from the National Institutes of Health. Dr. Murphy has gathered a group of medical professionals with experience in global and public health to lead center projects. Most have lived and worked in under-resourced countries. They understand the cultures and have profound respect for the people. He calls them the “troops.”

 

 

 

 

 

Shannon R. Galvin, MD, the center’s associate director for research and assistant professor of medicine, has come to Northwestern from the University of North Carolina (UNC)—home to an established global health center. While on staff at UNC, she lived and worked in the hospital wards in Lilongwe, Malawi. A poor country in southern Africa, residents of Malawi suffer from widespread famine as well as high rates of HIV and child mortality. “The people are wonderful and friendly,” she says. “They make do with what they have. Children play with cars made of chicken wire and soccer balls made of rolled up bags.” This ingenuity is reflected in the Malawian HIV treatment program, she notes, which has started thousands of people on HIV medications in a very resource-constrained setting.

The center’s director for African Research, Babafemi O. Taiwo, MD, a native of Nigeria, came to Northwestern five years ago as a fellow in infectious diseases. Now an assistant professor of medicine, his focus will be on HIV research and related problems such as hepatitis, tuberculosis, and malaria. Within the Division of Infectious Diseases, he will oversee two HIV research-related grants: the Fogarty and PEPFAR. Dr. Taiwo brings a “bidirectional perspective,” he says, achieved by having trained and worked in both Nigeria and the United States. Dr. Taiwo notes, “Having staff with diverse backgrounds enhances the center’s credibility to its mission of trying to engage a global community.”

Words like “bidirectional” and “bilateral” help guide the global health center’s mission and goals. Global health care in Dr. Galvin’s mind means encouraging medical students and faculty and those of partnering countries to do much more than pass each other coming and going like highway traffic. “It’s more about having a sense of what your partner country is capable of achieving and listening to the people—your colleagues—when they tell you what they need,” she says. Dr. Murphy agrees. “The concept of people from the United States and elsewhere going to poor countries, doing studies, and writing reports is long gone. Whether it’s us going over there and doing some training for them or them coming here and getting training and then going back, it’s a two-way street in the global setting.”

Oche Agbaji, MD, co-principal investigator of the PEPFAR grant based in Jos, Nigeria, exemplifies the direction the center is taking. Although a highly competent physician, Dr. Agbaji required training in the basics of clinical research such as drafting protocols and manuscript writing. Through a Fogarty grant, he recently spent one month in this country, two weeks of which were spent studying at Northwestern and the University of Chicago. “It’s important to understand that we are from two different parts of the globe in terms of development and issues,” he remarks, “but there are things we can gain from each other.”

Adding a unique twist to the makeup of the center are pharmacologists Kimberly K. Scarsi, PharmD, MSc, research assistant professor of medicine, and Kristin Darin, PharmD, research associate. Both will play major roles in training Nigerian and other African medical professionals in the use of HIV medication, including understanding side effects, drug interactions, and the principles and implementation of pharmacokinetic studies. Dr. Scarsi first worked internationally when she traveled to Botswana in 2005. A trip to Nigeria came shortly thereafter. She feels that the center staff’s practical experience in resource-limited countries helps them quickly assess what is practical and what is not. “How do you deliver health care when there is no running water, electricity, or doctors?” she asks, pointing out that she and her center colleagues have already faced these questions and found answers.

She describes a typical clinic scene as a mass of people, who patiently wait for hours to be seen. “When you come to the clinic in the morning 100 to 200 patients are waiting for you,” she describes. “Not only are they sitting in a very warm room not complaining, but they also are grateful that they are able to obtain this quality of health care.” Dr. Scarsi’s respect carries over to the in-country health care workers, too. She was grateful to meet these clinicians who work without complaint until every last patient has been seen. “Here we work from the heart, not for the money,” she recalls one Nigerian pharmacist telling her. “We are helping the people of our community and that is all anyone can hope for in a career.”

 

Playing integral roles in the development of the new center are (from left), Dr. Kimberly Scarsi, Adam Koon, and Drs. Babafemi Taiwo, Shannon Galvin, Baiba Berzins, and Kristin Darin.

 

In Botswana native dancers welcomed members of the PEPFAR program, including Drs. Murphy, Scarsi, and Darin, who attended the global group’s annual tri-country meeting involving Nigeria, Tanzania, and Botswana.

What started in 2005 as six sites in Nigeria has grown to 35, making personal visits to each site prohibitive in the typical 10- to 12-day visits conducted throughout the year. Now Drs. Scarsi and Darin focus on more “central training,” where staff from each of the sites attend a training session in a central location and then take the knowledge back to their clinics.

The center’s plans also include hiring an administrator to manage travel arrangements, visas, and grants, as well as an assistant director to coordinate all activities.

Medical students have served as one of the biggest motivators for the establishment of the Center for Global Health. Today’s students enter Northwestern having traveled extensively and expect such opportunities as part of their continuing education. Medical student Sara Patrawala from Rochester, New York, for example, studied in Germany while working on her undergraduate degree in environmental sciences at Northwestern. Last year she spent eight weeks in India working on a project: she compared obstetric perspectives between patients in a free clinic for the poor versus one that served a more affluent population.

In addition to student interest, all physicians increasingly require knowledge of global diseases as the world becomes a smaller place. Consider that the acronym AIDS requires no explanation anywhere in the world. The disease not only influences the physical health of people but also has impacted total economies and upset the balance of power politically. Today global health issues play a role in the practice of every physician whether he or she practices in Cairo, Egypt, or Cairo, Illinois.

Russell G. Robertson, MD, chair of the Department of Family and Community Medicine, serves as associate director of education for the center. Three existing department programs will serve as the framework for student travel experiences. Students can choose from programs offered by the Office of Medical Education (OME), the Office of International Program Development (IPD), and the Office of Global Health Education and Community Services (GHECS), explains Adam Koon, MPH, who helps coordinate global health education for the center. Koon has traveled to under-resourced countries as part of his MPH studies. He recently joined Northwestern from Emory University.

Those interested in traditional study experiences in Europe and other developed countries can choose from a number of formal affiliations offered by OME, including programs in Japan, Taiwan, France, Sweden, Germany, and the Czech Republic. If students desire an established curriculum with formal rotations in China, Uganda, South Africa, or Mexico, they can take advantage of IPD offerings. Finally, through an affiliation with the Heartland Alliance for Human Needs and Human Rights, GHECS offers clinical internships in Mexico and Guatemala that run from four to eight weeks. These shorter jaunts typically interest students completing their early years of medical school and looking for summer experiences. Often fourth-year students hoping to complete their electives abroad will work in clinics where there is a strong Northwestern faculty presence.

Recalling her senior year experience, Elizabeth K. Wolf, MD ’08, spent one month in Palacios, Bolivia, last year completing a family medicine rotation in a rural clinic remotely run by medical school faculty member Mark E. Molitch, MD, professor of medicine. “I saw unusual conditions such as Chagas disease,” recalls Dr. Wolf, “a parasitic ailment that I would never have seen in the United States.”

The Department of Family and Community Medicine also administers two different scholarships to support student travel through affiliated and unaffiliated programs at Northwestern. Recipients of the Ken and Ruth Davee Scholarship as well as the Global Health Initiative funding (see sidebar on opposite page) conduct primary care rotations and community health projects in developing countries.

Students often seek global health opportunities for two reasons: a cultural and/or educational experience or to work on a project. Both have merit. Students in the first group typically shadow physicians and “see what health care is like in another setting,” explains Dr. Murphy, adding that such an opportunity can be the beginning of a social consciousness that may lead to a different career path later in life. Those seeking project-related experiences visit a location where medical professionals need an extra pair of hands to manage data, help in a lab, or perhaps even see patients under the supervision of a licensed physician. The center has already set up some of these projects in Senegal, Malawi, Nigeria, Uganda, Kenya, and Tanzania.

Despite the medical school’s enthusiasm and support, the center will clearly need to focus its efforts to become a success, according to Dr. Murphy. Building sustainable reciprocal relationships takes time. He sees little expansion in Latin America or Africa beyond Northwestern’s present partnerships. Asia, however, is wide open, particularly Vietnam and Cambodia. On the European front, Dr. Murphy looks forward to a growing relationship with France’s Pierre et Marie Curie University–Paris, which ranks 39th out of the top 50 universities in the world.

Multifaceted, the center also serves as a testament to the school’s objective of providing volunteer medical services and relieving human suffering. Emphasizes Dr. Murphy, “Our mission in global health care is to help as many people as possible and to answer the important medical questions relevant to the people of the world.”

Giving Back to the World

Robert J. Havey, MD ’80, GME ’84, and his associates at Chicago Lake Shore Medical Associates (CLSMA) have come up with a unique way to give back—to the world. Through solicitations to their patients, they’ve raised more than $230,000 in support of the new Center for Global Health. This fundraising has made it possible for 63 students to visit several different sites, including Bolivia, Jamaica, Nicaragua, and South Africa. Their Global Health Initiative fund provides financial support to Northwestern medical students who would like to travel to under-resourced clinics around the globe to further their education. Through flyers in the waiting room, postings on their web site, and an annual fundraising event, CLSMA offers its patients an opportunity to provide charitable support that will make a difference in both global health care and the future of primary care medicine.

Pharmacologists fill vital role in new global health center

For pharmacologists Kristin Darin and Kimberly K. Scarsi, it’s all about empowering the people—particularly the health care professionals of Nigeria.

As members of the medical school’s new Center for Global Health, the duo play major roles in training Nigerian medical professionals in the use of HIV medication. Because health care providers must often keep an eye out for potential drug side effects and interactions in their patients, administering HIV medication is a tricky business made even more complicated with the existence of malaria and tuberculosis in underdeveloped countries. “Our goal in Nigeria is to empower the well qualified clinicians there by passing on our knowledge,” says Dr. Scarsi, research assistant professor of medicine. “Our effort feels a lot more sustainable that way.”

The pair visits the country approximately every two months for 10 to 12 days to conduct training sessions. “There are countries where you need to have a presence on the ground all the time but that isn’t true in Nigeria,” says Dr. Scarsi. “Their resource limitation isn’t human resources but rather training and education.” Compared with other underserved countries, Nigeria is blessed with well educated physicians, nurses, and pharmacists, she adds.

Using the “train the trainer” method of instruction, the center’s pharmacologists educate Nigerian health care practitioners who take the knowledge back to their sites and train other medical staff members. “At each training the participants take a pre- and post-test so we can assess what they have learned and where we need to improve,” explains Dr. Darin. “It is truly rewarding to see the progress make over the past few years. This is a training model that really works.” Sessions are held in a central location and focus on specific topics such as tuberculosis. Drs. Scarsi and Darin then conduct site visits to supervise and identify problems.

The two met while working at Northwestern Memorial Hospital in the area of infectious diseases. Both joined Northwestern to work under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) grant, a program launched in 2003 by the federal government to help combat global HIV/AIDS and supervised here at the medical school by Robert L. Murphy, MD, GME ’84, director of the Center for Global Health.

Dr. Murphy notes that PharmDs provide invaluable service in developing countries that are rolling out large antiretroviral treatment programs. Having these professionals on the Global Health Center staff makes the Northwestern program unique.

“Treating HIV/AIDS, tuberculosis, and malaria is all about making a diagnosis and then giving relatively complicated drug treatment regimens,” says Dr. Murphy. “The PharmDs, who are pharmacologists with advanced graduate training, provide the technical assistance to local pharmacists and clinicians caring for infected patients.”

In addition to providing the training, Drs. Darin and Scarsi also forecast drug usage and supply chain management which accounts for up to 50 percent of the entire AIDS treatment budget for many countries, he adds.

Janet DeRaleau