This has been the most inspiring three days of lectures that I have ever had! I love it! There are about 70 students here at the National Institutes of Health in Bethesda, MD, half from the US and half from abroad. We have varied levels of training from medical students to PhDs, and in all specialty areas from cardiology to veterinary medicine.
Dr Pierce Gardner, one of the founders of the Fogarty International Clinical Research Scholars program, said today "The concentration of idealism that I am immersed in today is so exciting and makes me feel goot that the world is going in the right direction." It is fun to be surrounded by such amazing people with diverse backgrounds and experiences who are all passionate about global health and research.
Here's a quick review of my Fogarty Orientation.
Flight. Expensive. Basically, I was charged $90 for packing over 50lbs plus $40 for having two carry-on and the rolling suitcase broke when I arrive. On a good note, I'm moving to Peru and all my stuff fits in two (kinda) bags.
Registration. Simple.
Hotel. Sweet with a rooftop pool!
Roommate. Awesome. My foreign "twin," Romina, is from Peru and speaks perfect English (to my pathetic Spanish). She is very friendly and pursuing a PhD in Epidemiology in Lima. I look forward to working with her and going on lots of adventures this year with her (and the 10 other from the Fogarty who will be in Peru with me).
Who's the most famous Macalester alum? Anyone... Kofi Annan, former UN Secretary General! We talked a bit about him today and his initiative to get world leaders to make a commission on macroeconomics in 2000 which lead to the Millennium Development Goals. Check 'em out. http://www.un.org/millenniumgoals/
The goals are simple: to end poverty by 2015. Are we there yet? NO WAY! But that's where the Fogarty comes in as many of these goals are interconnected with health and improving the health of a community can have a significant impact on quality of life, education, and productivity. But what are the health problems, what is the epidemiology of these disease, how do cost-effectively treat, and how do you measure if your interventions are having an impact? That's why I'm here: to learn how.
Epidemiology 101: How do you take a pulse on a population?
Col. Michael Lewis spoke today about how we transition our thinking from clinical medicine to epidemiology, aka individuals with disease we treat to populations where we prevent and control disease. This crash course was a nice review of public health, epi, and biostatistics. I hope to conduct research on primary and secondary prevention of cardiovascular disease, or simply put, preventing the disease by removing the risk and/or delaying the disease occurrence. Most of the current research in cardiology is on secondary prevention and screening and detecting disease or tertiary prevention where we try to minimize the effects of the disease and associated disability.
Microeconomics 101: I have never taken econ but this was the best health economics crash course. Rachel Nugent from the Center for Global Development, a DC think-tank, talked about cost-minimization (where we look at the costs associated with achieving a specific goal. Example: a huge campaign to deliver vaccinations to children in Africa), cost-effectiveness (where we compare the costs per unit of a health metric, like disability-adjusted life years, a fancy way to quantify morbidity and mortality of any medical condition. Example: is it more cost effective to do family planning or educate young girls to decrease greenhouse emissions?), and cost-benefit (which is very difficult to do in healthcare because it compares costs across sectors. Example: what has a greater benefit educating all young girls in a country or vaccinating children against name-your-disease? or does it make a difference if we do blood pressure screening vs build sidewalks in a community?). Very interesting discussion with lots of ethical questions as well. Do you diagnose if it's not cost effective to treat? Interestingly, if an intervention is lower than three times the average annual income per person than it is deemed "cost effective." For the US that's $90,000/yr, for Peru it's $5400/yr and for Mali it's $1800/yr.
Research in Developing Countries 101. Inspiring. Neglected tropical diseases (NTD) (hookworm, roundworm, trichuriasis, schistosomiasis, elephantiasis, trachoma (blindness), opisthorchiasis (liver fluke), and onchocerciasis (river blindness) are all chronic, debilitating diseases since they occur largely in endemic areas and individuals typically cannot fight them off. They are not as sexy at HIV/AID, malaria or tuberculosis but according to the DALYs, they cause almost as much morbidity and mortality as ischemic heart disease worldwide, and more than stroke or malaria. There are 1.4 billion people who live on less than $1.25/day, aka no money. Most live in urban slums or are subsistence farmers in 58 nations and 73% of these "bottom billion" live in areas of conflict or civil war. For example, Haiti has 8 million people with five or more NTDs and for only $0.50/yr, or $4 million, we could treat these NTDs by giving one time dose of four antibiotics. How many visitors go to Haiti every year? 20 million, How much do they spend? Billions. If every person gave $1 when the visited we could treat the NTDs for five years. Wow.
In addition, there are many neglected diseases in the US where there are 300 million people, 12% who live in poverty (<$30,000/year) and are largely burdening minorities. Access to healthcare in the US is also a barrier, as it is abroad. We have to work to educate people to decrease DALYs from NTDs.
Ok I'm off my soap box... next time I'll just talk about the cultural things, like my personal tour of the US Capital on Saturday!
