Students and clinical preceptors from American University of the Caribbean School of Medicine (AUC) and the Center for Haitian Studies (CHS) participated in the university’s first Global Health Symposium earlier this month. The event, held at Jackson Memorial Hospital in Miami, Florida, provided a platform for attendees to hear and discuss emerging global health issues and innovative solutions that are driving change.
Left to right: Dr. Robert Hecht, Shaun Garcia, Dr. Andre Vulcaine, Dr. Michele Dodard, Linda Klumpp, Christopher Hubbard, and Dr. Larry Pierre
A Look at Global Medicine Today
Few people can discuss the state of global medicine in 45 minutes but it appeared an effortless task for Michele Dodard, MD, Associate Professor of Clinical Family Medicine and the University of Miami Miller School of Medicine and Director of the school’s Office of Community Medicine.
Standing at a podium—charts and graphs projected on a screen to his left—Dr. Dodard explained the most pressing health challenges facing developed and developing countries. While non-communicable conditions such as heart disease, stroke, respiratory disease and cancer carry the burden of disease in high-income countries like the United States, infectious diseases such as HIV/AIDS, malaria, tuberculosis continue cause the majority of deaths in low-income countries.
For Dr. Dodard, issues like tuberculosis and malaria remain top of mind. While these diseases rarely makes news headlines, they continue to kill millions of people a year.
“Twice I have diagnosed malaria in the United States—in people who traveled here from Africa and Trinidad,” he said. “These problems are here and we are very much still fighting them.”
>> Read more about tuberculosis from Professor Stephen Ash, UK Clinical Dean
In addition to disease, Dr. Dodard highlighted other emerging threats to global health: air pollution, deforestation, climate change, and healthcare workforce shortages—which have become a major roadblock to implementing large scale global health programs. Shortages are especially devastating in regions like Southeast Asia, India, and Africa where 3 percent of the world’s trained workers are carrying 24 percent of the global disease burden.
But he did note a bright spot. Low-cost interventions in developing countries have dramatically reduced the number of preventable child deaths. In just six years, for example, measles immunizations by community health workers have decreased child deaths from measles by 60 percent. That in addition to oral rehydration, vitamin A, and micronutrients supplementation has resulted in millions of lives saved each year.
“All health issues are global health issues. Someone with an infectious disease in Paris can be in the United States in less than 24 hours. We don’t live in a bubble anymore.” - Michele Dodard, MD
Dr. Dodard left attendees with one final thought—a quote from Dr. Barbara Starfield, professor at the Hopkins School of Public Health: “Countries with strong primary care services achieve better health levels at lower costs and with greater equity in the distribution of health across population subgroups.”
Zika Tops List of Global Health Topics in 2017
While Dr. Dodard’s presentation covered a wide range of global health issues, three AUC students focused on one popular concern: Zika. In their presentation, “Global Health: Zika and Pregnancy,” Linda Klumpp (MS4), Christopher Hubbard (MS3), and Shaun Garcia (MS3) tackled the mosquito-borne disease that has dominated news over the past two years. In fact, WebMD reports that online searches for Zika symptoms rose over 400,000 percent in 2016 alone.
>> Read our Q&A with Linda Klumpp: Medical Student and HIV Advocate
Garcia kicked off the presentation with a brief history of the Zika virus—both its origin (Uganda in 1947) and the 2015 headline-grabbing outbreak in Brazil. That outbreak signaled the first time the virus had been linked to microcephaly, a birth defect that impedes brain development. Scientists now believe that the virus traveled to Brazil via an infected French Polynesian athlete at the Va’a World Sprint Championship canoe race in August 2014.
In May 2017, Brazil announced the end of its Zika public health emergency (infection rates are down 95%); however, Garcia noted that the mosquito-borne virus persists in other parts of South America, Africa, India, North America, Central America and the Caribbean today. On May 15, 2017, for example, the World Health Organization confirmed three cases of Zika in India and clinics in Haiti continue to be flooded with patients.
While there is currently no vaccine for Zika, the student presenters discussed the progress of multiple agencies toward developing one. As those efforts continue, healthcare providers remain focused on preventing the transmission of the disease and screening and assessing pregnant women and their babies for exposure.
For her part of the presentation, Klumpp highlighted multiple tools and resources developed by the Centers for Disease Control and Prevention to help guide healthcare providers to do just that. A comprehensive algorithm (see below), for example, instructs providers when and how to test for Zika in pregnant women presenting with symptoms. Depending on length of symptoms, the CDC recommends either a Zika RNA nucleic acid test on serum or urine (symptomatic for less than 2 weeks) or a Zika immunoglobulin test on serum (symptomatic for 2-12 weeks). Positive tests should then be sent to the CDC for further confirmation.
In the United States, 1,471 pregnancies with Zika were reported between 2016-17. Of those, 64 infants were born with birth defects and 8 pregnancies were lost due to birth defects.
While Zika control efforts have helped in some parts of the world, the virus continues to emerge as a threat in others. Given Zika’s association with brain abnormalities, students concluded that surveillance efforts should continue globally.
Following the event, each student received an Outstanding Student Presentation Award for their research and contribution to the program.
Bonus Case Study:
Sunny Isles, FL Patient Presents with Zika Symptoms
As a part of their presentation, Garcia, Klumpp, and Hubbard reviewed an August 2016 patient case study from Dr. Jose Antonio Soto, family physician at Soto Medical Associates. According to Dr. Soto, a 20-30 year old woman living in Sunny Isles, Florida arrived to his office complaining of a pink rash, headaches, and vomiting over a period of five days. The patient had also recently traveled to Sao Paulo, Brazil and Puerto Rico, two areas known to have Zika. Suspecting Zika, Dr. Soto ordered labs for Zika, Hepatitis A, B, and C, and Dengue IgM and IgG and counseled the patient to stay home and avoid aspirin and other non-steroidal NSAIDS, which can prolong bleeding. Two weeks later, the labs came back and the patient tested positive for the Zika virus blood test.