CHILDREN'S GLOBAL Health Initiative
April, 2012 – CGHI Program Director, Deborah Dean, MD, MPH, was invited as the Plenary Speaker to this year's University of Utah Annual Global Health Conference on April 13th, 2012.
The University of Utah's global health conference is unique in that it brings together students, residents, nurses, pharmacists, doctors, physician assistants and researchers from across a variety of different disciplines and at all different educational levels to highlight various global health initiatives being undertaken worldwide. The venue provided key outreach opportunities to a variety of different individuals looking for volunteer opportunities through the CGHI.
As the plenary speaker, Dr. Dean provided an overview of CGHI, specifically highlighting the CGHI focused country program in Vietnam.
"It's always a pleasure to discover what other global health initiatives are doing and understand their framework for success in addition to the challenges, they face" says Dr. Dean.
"The conference was a great opportunity to network, share our experiences in global health, learn from each other, and connect dozens of individuals looking to become involved in our projects."
In 2011, Children’s Global Health Initiative (CGHI) was honored to be on a very short list of global health initiatives to be selected by Global Health TV for a short film. Produced by WebsEdge, Global Health TV brings the global health community together by sharing inspiring stories on the work being doing around the world through online films.
Each year, Global Health TV screens a variety of global health initiatives looking for just the right kind of project from which to create a short film. The films are posted on YouTube, Global Health TV, and are shown on continuous feed throughout the annual Joint Global Health Conference in Montreal, Canada. A collaborative effort from the Global Health Education Consortium (GHEC), the Consortium of Universities for Global Health (CUGH) and the Canadian Society for International Health (CSIH), the annual conference, which was November 13th to 15th, brings together all the major players on the international global health stage, such as the Gates and Rockefeller Foundations, Fogherty International, and the National Institutes of Health.
“Being selected by Global Health TV is such an honor,” says CGHI Director, Deborah Dean, MD, MPH. “Not only does it make us feel great about the work we are trying to do, but by showcasing our project at the Joint Global Health Conference, Global TV is giving us an incredible opportunity to network with key individuals and organizations in global health.”
The short film highlighted one of CGHI’s many global initiatives, this one in Phu Tho Provence in Northern Vietnam. The project involves utilizing the Vietnamese governments agricultural infrastructure to provide a micronutrient food supplement to women prior to pregnancy in an effort to boost maternal health and improve newborn outcomes.
“It was a fabulous experience to have Global Health TV come out to our project and see what we are doing on the ground there,” says Dr. Dean. “We are very excited about the project, which tackles maternal nutritional health from a pre-conception angle for the first time. It was indeed an honor that Global Health TV wanted to share our story with the rest of our global health community.”
At least three new partnerships with CGHI arose from the Joint Global Health Conference and the continuous screening of the Global Health TV film, which can be found on YouTube at http://www.youtube.com/watch?v=zcubAnCgy_k.
September, 2011 - The CGHI was pleased to host a visit from Father Bonaventure Turyomumazima, PhD, Coordinator and Member of the Board of Directors Holy Innocents Children's Hospital (HICH), Uganda, and Chancellor of Mbarara Diocese, Uganda. In July of 2010, CGHI medical professionals helped install a neonatal unit, a community nutrition study and emergency medicine triage protocols at HICH. In addition, CGHI members continue to participate in the education and training of HICH clinicians in an ongoing collaborative effort between CGHI and the Ugandan hospital, which is the country's first-ever exclusive children's hospital.
The collaboration has been so beneficial to the HICH that Father Bonaventure wanted to personally reach out to those individuals and organizations that have, through the CGHI, been instrumental in the continued collaboration. Father Bonaventure gave a presentation at grand rounds at Children's Hospital Oakland, and was welcomed at Children's Hospital Oakland Research Institute following grand rounds for a reception hosted by the CGHI.
On May 14th, 2011, the Children’s Global Health Initiative (CGHI) held a research symposium with Collaborate for Africa (C4A) at Children's Hospital Oakland Research Institute (CHORI) to bring together CGHI researchers and clinicians, and the diverse members of C4A. Collaborate for Africa is a networking organization designed to connect individuals who have an interest in Africa with individuals who have the resources to translate that interest into positive action.
“Collaborate for Africa connects people from all different walks of life – financial people, information technology folks, physicians – anyone and everyone interested in either healthcare or environmental problems in Africa,” explains Jeff Chow, Founder of C4A.
“By creating a joint event between Collaborate for Africa and the CGHI, we were able to showcase the important work we are doing in Africa for those most interested in helping make the kind of work the CGHI is doing a reality,” explains Deborah Dean, MD, MPH, CHORI scientist and CGHI Program Director.
Launched in 2008 with the mission of enabling sustainable global health for children and their communities through education, training, clinical care and translational research, the CGHI is a joint effort between clinicians at the hospital branch of Children's Hospital & Research Center at Oakland and investigators at CHORI to create sustainable programs across the globe. Although the CGHI promotes local in-country clinical and institutional collaborations in over 20 different countries worldwide, the May symposium focused primarily on current projects in Africa.
"To name just a few, we had Dan Granoff, PhD, talking about his work with meningitis in sub-Saharan Africa, and Mary Coleman, MD, who has been providing services and training at the only pediatric hospital in Uganda. Pricilla Joe, MD presented on her work on neonatology training regarding infant resuscitation in Uganda, and Desiree LaBeaud, MD, MS, discussed Rift Valley Fever in Kenya," says Dr. Dean.
A combination of both scientists conducting research and doctors providing services and training, the presentations highlighted the variety of ways in which the CGHI provides a venue for the medical and scientific world to collaborate in the development and implementation of preventative strategies and cures for diseases across the globe, and Africa in particular.
"The potential collaborations that are underway from bringing all of these people together in the same place are just phenomenal, from folks interested in helping provide Internet systems for data transfer from clinics in Africa back to local U.S. resources, to healthcare professionals who want to know how they can participate," says Dr. Dean.
CHORI senior scientists and CGHI team members Janet King, PhD, Deborah Dean, MD, MPH, and their colleagues Andrew Hall, PhD, Tu Ngu, MD, PhD, and Henri Dirren, PhD, have received funding from the Thrasher Research Fund and the Nestle Foundation to study for the first time whether or not providing increased nutrition to women prior to conception can impact fetal health and improve birth weight. In combination with the Vietnamese VAC program, which can be translated as vegetables, aquaculture (or fish), and caged animals (chicken and pork), and supported by the Vietnamese government, the new study has the potential to revolutionize maternal and newborn health in Vietnam.
"If we are able to show that providing even just a small intake of animal source foods has a positive impact on pregnancy outcomes, the Vietnamese government will then make sure that all pregnant women have access to animal source foods every day," says Dr. King. "It's a wonderful opportunity to really have an impact on maternal health."
Depending on how maternal health is defined, as many as a third of the world's population of expecting mothers are micronutrient deficient. In Southeast Asia in particular, researchers estimate that 25 percent of newborns suffer from the malnutrition of their mothers. The result is lower birth weights, greater susceptibility to infection, and significantly increased morbidity and mortality. While researchers have understood the impact that malnutrition can have on the health of the newborn for decades, nutritional interventions have failed to show significant positive results.
"In my opinion there are two principles at work that can explain the lackluster success of these interventions," says Dr. King, an international expert in maternal nutrition, and zinc deficiency, in particular. "One is that you cannot live on vitamins and minerals alone. We need energy, we need protein, we need food."
No matter how much supplementation you provide in the form of vitamins and minerals or fortified foods, says Dr. King, you can't make up for an incomplete diet. No amount of vitamins can do enough to augment the consumption of only rice and a few vegetables, often a staple diet in rural communities.
"The second principle is that a key factor influencing the course of pregnancy is the nutritional state of the mother at conception," Dr. King says. "We don't have a lot of human data to support this, but we have a huge amount of animal data."
"Everyone knows before you breed an animal you want to make sure that animal is well nourished. This is the backbone of animal husbandry throughout the world, and the basis of our food supply. Somehow, however, this knowledge hasn't been translated to people."
Instead, maternal nutrition interventions have always focused on providing nutritional boosts in the form of supplements and vitamins only when a woman has already conceived. The new study addresses both these principles by focusing on newly married women who have not yet conceived, and by providing not a pill, but a food snack.
"Vietnam is one of the only countries in the world that has been actively working to make sure they maintain an agricultural infrastructure to provide a varied food source for their people, through their VAC program," explains Dr. King. "The communist government provides land to farmers in rural areas for them to produce VAC foods, and consequently, they have maintained animal source foods sufficient to supply the entire population of Vietnam."
The problem, however, has been the distribution of those foods. The rural farmers are so poverty-stricken that they must sell all their meats, and forgo such consumption themselves.
In addition, because of cultural issues, any meat consumed at home generally goes to men. Thus while there is an adequate supply through the VAC program, the nutrition found in animal source foods – iron, zinc, vitamin A and vitamin B12 – doesn't get to those who need it most – pregnant women and their children.
"What we are doing is developing 10 different food snacks that come from eggs, pork and chicken, that we provide on a daily basis to both potential but not yet pregnant women, as well as already pregnant women," says Dr. King. "It's a study I have wanted to be able to do my entire career – to provide nutritional supplementation to women pre-conception."
It's also a study that utilizes a fundamental part of the Vietnamese government's existing agricultural and food policies, which means that translating the potential positive results into clinical practice – making sure women and children get meat proteins every day – will not only be supported by the government, but will be inherently implementable.
"We can have as many policies and World Health Organization recommendations we want, but if you really want to have an impact, you have to find a way that works for the individual cultures and governments to get the nutrition to those who need it most," says Dr. King.
With the help of the Thrasher and Nestle Foundations, Dr. King is helping make that happen. The three-year grant began November 1, 2010, and its results will hopefully provide not only a foundation for increasing maternal health in Vietnam, but also a framework for how to combat maternal malnutrition and low birth weights on a global scale.
In 2000, the United Nations (UN) brought together the largest gathering of world leaders in history to develop and adopt 8 different Millennium Development Goals (MDGs) geared toward tackling global poverty and its inequities. Since then, the UN has been annually recognizing organizations that have made outstanding contributions toward achieving the MDGs.
Last year alone over 40 Nobel laureates were presented with the award. In 2010, however, the Children's Global Health Initiative (GCHI) was among 4 organizations in northern California given the great honor of receiving the United Nations Global Citizen Award for the GCHI's dedicated efforts to help achieve MDG 4, the reduction of child mortality.
"Like many organizations, we do all our work in developing countries by invitation to work on a particular medical or research problem, but we also do training and education so that what we develop becomes sustainable after we leave. I think that really distinguishes us," says CGHI Program Director, Deborah Dean, MD, MPH.
Launched in 2008 with the mission of relieving suffering and meeting the needs of children worldwide in an environment of trust, compassion and care, the CGHI focuses on the most vulnerable population on the planet - children.
"Over 10,000 children under the age of 5 years die of diarrhea, lung infections, malaria and measles each year, many complicated by malnutrition, and all are preventable," says Dr. Dean.
The CGHI serves as an umbrella under which scientists and clinicians in Children's Hospital Oakland Research Institute (CHORI), the research arm of Children's Hospital & Research Center Oakland, conduct global outreach to developing countries, providing research collaborations and essential services that all contribute to reducing child mortality.
CGHI scientist Janet King, PhD, has been working on obesity, diabetes and malnutrition in pregnant mothers in a variety of developing countries, as well as working with Dr. Dean on how malnutrition can impact the immune response to infections in among rural Vietnamese women of child bearing age.
"If you decrease the mortality of mothers by providing them with better services and prevent malnutrition, you increase the likelihood that the children they are giving birth to will survive," explains Dr. Dean. "If you provide surgery to cure blindness in elders who would otherwise not be able help care for infants and children, you increase the likelihood that those children in their care will survive."
This is but one of the many examples through which the CGHI champions children across the globe, and the efforts of CGHI that were so honored by the UN Global Citizen Award.
"We have something we can translate to the third world, whether it's a technology or a medical treatment regimen or a protocol that can be incorporated into their own clinical work," Dr. Dean says. "We help provide stability by educating and training people on the ground to carry on with the work after we leave." Apparently the United Nations agrees.
April, 2010 - Haiti has dropped from the headlines, but the need for aid is as strong as ever — and a group of doctors and nurses from Children’s Hospital & Research Center Oakland who are part of Children’s Global Health Initiative (CGHI) responded with a 10-day trip to Port au Prince in May, 2010. A specialized pediatric surgery team including a plastic surgeon, anesthesiologist, nurses and respiratory therapists armed with 35 boxes of donated medical supplies deployed on May 27 to aid the children of Haiti in need of medical care. Global Healing, one of CGHI’s partners and a Bay Area-based non-profit organization dedicated to bringing modern medicine to the developing world, funded the trip.
When the earthquake hit in January, Haiti was flooded with humanitarian aid. Almost six months later, the aid was dwindling but the need for medical supplies and services remained extremely high.
According to CGHI pediatric intensivist and stateside team coordinator, Arup Roy-Burman, MD, medical needs persisted, but the kind of need evolved.
“Major acute general trauma and orthopedic injuries have been replaced by the aftermath of the initial injuries, including poorly healed and infected wounds. In addition, there has been a rise communicable diseases such as diphtheria,” explains Dr. Roy-Burman, who is also chairman of the board for Global Healing.
“In recognition of this evolution in medical needs, along with the waning of medical support, CGHI and Global Healing are joining together to provide medical assistance to those still in need in Haiti.”
In Port Au Prince, 10 of the 14 member CGHI’s medical volunteer team worked at Adventist Hospital where the current patient population is almost 50 per cent children. The team offered both pediatric and adult support in plastic and reconstructive surgery. The rest of the team was stationed at the University Hospital of Haiti, where they assisted in both basic pediatric and pediatric intensive care. Loma Linda University coordinated the primary team at Adventist, while non-profit health care organization Partners in Health coordinated the University group on the ground in Haiti.
“Global Healing is happy to be working together with Loma Linda University and Partners in Health, and the CGHI to support Haitians during this on-going state of current emergency,” said Cindy Basso Eaton, president of Global Healing. “With the onset of serious disease and the critical need for medical support, I am confident that the team from CGHI will help make a difference as the state of emergency in Haiti still exists.”
Revised: Friday, February 14, 2014 4:16 PM