Working where the need is
Emory health sciences faculty and students travel the globe, providing care and establishing partnerships within other countries to address intractable health challenges like tobacco use, diabetes, and AIDS. What they do there helps both individuals and populations, now and for generations to come. What they learn from these experiences has indelible effect on their own lives and on the collective life of Emory as a whole.
GOING GREEN Emory Healthcare has worked hard to reduce, reuse, and recycle, including working with MedShare International (pictured above), a nonprofit organization dedicated to improving the environment and health care through redistribution of surplus medical supplies and equipment to underserved health care facilities in more than 75 developing countries. Since 2007, Emory Healthcare has collected more than 160,000 pounds of supplies for MedShare, including 21,446 pounds in 2009 alone.
One Saturday each month, Emory Healthcare employees gather at Atlanta's MedShare national headquarters and Southeastern distribution center in nearby Decatur, Ga., to sort supplies like gloves, gowns, surgical instruments, and anesthesia devices and ready them for shipment to needy countries around the world. These are supplies remaining from bulk packaging that remain in sterile packaging but cannot be restocked, per guidelines in this country. This work helps ensure not only that these supplies go where they can be put to good use but that they stay out of local landfills.
THE EMORY VACCINE CENTER, directed by Rafi Ahmed, has partnerships around the globe, including with the Australian Centre for Vaccine Development at the Queensland Institute of Medical Research and with the International Center for Genetic Engineering and Biotechnology in New Delhi, the latter to develop vaccines against diseases that disproportionately affect India and other parts of the developing world.
TWO YEARS AGO, Emory Healthcare opened its heart and medical resources to Isabelah Robi, a Kenyan woman whose first worry, when her breast cancer was detected, was what would happen to the 600 students she had "adopted" in her remote Kenyan village. Although she long since returned to her home after clinicians at Emory Winship Cancer Institute treated her cancer, they continue to this day to provide her with drugs for hormone therapy.
This year, when Emory Winship pharmacist Mike Bloomfield made his own annual personal trek to Kenya, three Emory Winship oncology nurses accompanied him. The team completed physical exams on all 600 students under Robi's care, their 30 teachers, and dozens of villagers. They also saw how, under the direction of Robi, the school's aggressive feeding program had nursed children from severe malnutrition to health. But the best sight of all, said Bloomfield, "was to see how a life saved by the care and generosity of Emory Winship helped save the lives of hundreds of children."
REDUCING TOBACCO USE IN CHINA: How glamorous, adventurous, and socially acceptable smoking was back in the days of Bogart and Bacall, when ad campaigns touted one cigarette brand as that "most often chosen by doctors." The Surgeon General's 1964 report on the dangers of smoking was insufficient by itself to make Americans snuff out their cigarettes, but during the past four decades a combination of strategies, interventions, and policies have changed Americans' view of tobacco use.
Now, using lessons learned in this country, the Emory Global Health Institute (GHI) and the Tobacco Technical Assistance Consortium (TTAC), the latter located in Emory's Rollins School of Public Health, are collaborating with Chinese public health leaders to reduce smoking in that country. As the number of U.S. tobacco users has fallen, the number of Chinese smokers has continued to rise, currently totaling 400 million.
That's why Emory's GHI director Jeffrey Koplan asked TTAC to consider taking its U.S. tobacco control program global and why the Bill & Melinda Gates Foundation decided to fund the Emory GHI-Chinese Tobacco Partnership to the tune of $14 million. Working at the local level, the partnership will help four to six Chinese cities develop programs and policies with the greatest potential for eliminating tobacco use, sustaining anti-tobacco norms, and building a healthier, tobacco-free China.
EACH SPRING BREAK, a group of Emory nursing students travels to the Caribbean, not for fun in the sun but to help and learn from patients there. This year, they went to Eleuthera, in the Bahamas, where they worked in local clinics. At a local community center where elderly locals gather, students led yoga sessions, gave massages, and discussed the importance of managing hypertension and diabetes. At left, a student works with a nurse in the pharmacy at Governor's Harbor Clinic.
DECREASING MATERNAL DEATHS: Why were new mothers dying in the Dominican Republic—15 times more often than in the United States—despite a large network of public hospitals where most pregnant women went to give birth? Emory nursing faculty member Jenny Foster, a midwife with a doctorate in medical anthropology, was a member of the team of nurse-midwives asked to try to change those dismal statistics.
After intensive interviews at the large Dominican hospital requesting help, team members told the nurses what they themselves already knew: they were stretched too thin, with inadequate resources for follow-up after mothers delivered. In full collaboration with the Dominican nurses and the community, Foster and her colleagues came up with a three-pronged plan. First, the local nurses would receive additional training in available technology; second, they would train volunteers in the community to be doulas, available to help women after childbirth. And third, Foster would work with health care providers, women, and others, including men who had watched their wives die after childbirth, to determine if women understood dangerous symptoms during pregnancy and how well nurses were communicating with patients. The community was involved in every aspect of the research. Last year, the hospital reported no maternal deaths.
LEARNING MEDICINE, WESTERN-STYLE: For years, Emory's schools of medicine, nursing, and public health have helped build the health system in Atlanta's sister city Tbilisi, Georgia, in the former Soviet Union. In 2006, Emory helped clinicians in Tbilisi establish the first modern pediatric emergency room in any country from the former Soviet Union, and now they are helping implement an emergency medicine residency program to train clinicians in this specialty. Most recently, Emory received $2 million from the U.S. Agency for International Development to develop a nursing program and train more than 1,600 nurses in the Georgia capital. Emory Healthcare nurse Laura Hurt, director of nursing operations at Emory University Hospital Midtown, will make multiple trips to Tbilisi to get the program up and running and to begin the teaching process. The immediate goal is to improve the standards of currently practicing nurses through in-service vocational training (both classroom and clinical), with a long-term goal of establishing a degree-granting nursing school that will produce future leaders of the nursing profession in Georgia.
THE NEXT GENERATION OF GLOBAL SERVICE: Students interested in health professions are drawn to Emory for its emphasis on service, at home and around the world. Javier Gutierrez, for example, is a Colombian physician who this year received his master's from Emory's Rollins School of Public Health. After graduating from Bogotá's best medical school, Gutierrez set out for a distant outpost in the jungle to complete his obligatory rural service. In the isolated community, he saw maladies urban physicians rarely see and treated patients who had never seen a doctor. When the only hospital in the area closed, he and his wife took their savings and begged loans from friends to open a clinic in a small hotel on the edge of town. A decade later, the clinic has 28 beds, two surgical rooms, two delivery rooms, and an ER. Gutierrez was one of six students to receive Emory's Humanitarian Award for 2009.
EMORY OPHTHALMOLOGY RESIDENT Grace Prakalapakorn (foreground) was one of several eye specialists on a recent trip to Santo Domingo in the Dominican Republic by ORBIS, the "flying eye hospital." ORBIS volunteers treat patients and train clinicians in developing countries all over the world. Prakalapakorn joined ORBIS following completion of her residency training at Emory.
VENKAT NARAYAN IN THE ROLLINS SCHOOL OF PUBLIC HEALTH is principal investigator of the Emory portion of an NIH-funded partnership with the Public Health Foundation of India to establish a global center for prevention and control of "cardiometabolic" diseases in South Asia. Center researchers will test 4,000 people in each of three cities in India and Pakistan in an attempt to postpone and control heart disease. They will also recruit 1,200 people living with diabetes to test effectiveness of various treatments and care strategies for diabetes and heart disease. Both diabetes and heart disease disproportionately affect people in this region.
The South Asia region includes three of the top 10 countries in the world in terms of people wih diabetes (India, Pakistan, and Bangladesh), and is the region with the highest number of diabetes-related deaths. Asian Indians are projected to account for 40% to 60% of the global cardiovascular disease burden over the next 10 to 15 years. In addition, 35% of cardiovascular disease-related deaths in India occur in people aged 35 to 64 compared with just 12% of people in those age groups in the United States.
