The Global Burden of Obesity
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Summer Course in Peru
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Global Health Tulane University School of Public Health and Tropical Medicine
Building a Hospital in Rural Ecuador
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volume 8, number 2 fall/winter 2008
M e ss a g e F r o m t h e D e a n Dear Friends,
PaulaBurch-celentano Burch-celentano Paula
As the Tulane University School of Public Health and Tropical Medicine nears its 100th anniversary in 2012, I’m struck by how relevant a global public health education is today. As the current chair for the global health committee of the Association of Schools of Public Health (ASPH), I can attest to the vital and important role that schools like ours play not only in communities around the world, but also in cities, towns, and neighborhoods in the U.S. This issue provides examples of Tulane faculty, students, and alumni working on global issues. Our cover story will introduce you to one alumnus who has developed a model for sustainable health care in Latin America. In health research, you’ll learn how a doctoral candidate in epidemiology worked with other Tulane researchers to quantify the global burden of obesity. And you will read how our chair of community health sciences spent a year at the New York City Health Department working on a number of global issues, including the rise in obesity, the spread of HIV, and the management of conditions like high blood pressure and diabetes. In each of these stories, you will hear how what is local is also global. It’s true that there is a greater need than ever before for professionals trained in global public health. Tulane is answering that call. This past spring, the university graduated its first undergraduate class in public health. Thanks to a Framework Program grant from the Fogarty International Center, in 2009 the university will also begin offering certificates in global health to graduate students from any Tulane school or department. As Tulane has done for nearly 100 years, we will continue to address the public health needs of our world through education and research. Best regards,
Pierre Buekens, MD, PhD
A w e l c o m e t o n e w fa c u lt y N e w Appo i n t m e n t Katherine Andrinopoulos, PhD, assistant professor, international health and development
C o n g r at u l at i o n s t o C u r r e n t Fa c u lt y P r o m ot i o n s Charles Miller, PhD, professor, environmental health sciences Carolyn Johnson, PhD, professor, community health sciences
View faculty profiles at www.sph.tulane.edu/faculty
Global Health Editor | Dee Boling Assistant Editor | Laura Post Contributing Writers | Keith Brannon, Arthur Nead, Laura Post, Ryan Rivet, Fran Simon, Madeline Vann
inside
Photographers | Paula Burch-Celentano and Holly Scheib Design | Sarah Chesnutt
Health Research News
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Publication
Post-Katrina Distress
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Worldwide Obesity Impact
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Peru Summer Course
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cover story Building a Hospital in Rural Ecuador
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Global Health is published twice per year by the Office of the Dean at Tulane University School of Public Health and Tropical Medicine. It is distributed to alumni and public health colleagues. Please update your contact information at www.sph.tulane.edu/alumni.
Alumni Notes
Special thanks to University Publications.
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Submissions We continually seek content for publication. Please submit alumni notes, stories, and photographs to Editor, Global Health, 1440 Canal St., Ste. 2430, TW-13, New Orleans, LA 70112. Send inquiries and/or emailed submissions to
[email protected].
Administration Dean | Pierre Buekens
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Senior Associate Dean for Academic Affairs | Ann C. Anderson Associate Dean for Admissions and Student Affairs | Jeffery T. Johnson Associate Dean for Graduate Medical Education | M. A. Krousel-Wood Director of Academic Information Services | Fran Mather Assistant Dean for Finances | Susan Barrera
Alumni Board Nicole A. Boyer; Ann H. Byerly; Edward R. DeSocio Bernard H. Eichold II; Janet I. Guptill Lori Hoepner, president; Penny Jessop Sally T. Knight; M. A. Krousel-Wood; F. Brobson Lutz Ann Metzinger, secretary; Elaine Ricketts, president-elect NancyKay Sullivan-Wessman, vice president; C. Alison Walker
Ex-Officio: Cynthia T. Hayes and Pierre Buekens Holly Scheib
C o n t r i b u to r s ’ Not e s Keith Brannon is assistant director of public relations for Tulane University. Paula Burch-Celentano is a staff photographer in the Tulane Office of Publications.
Peru summer course students get first-hand experience in public health, see page 6.
Arthur Nead is a media specialist for Tulane University. Laura Post is the communications coordinator at Tulane school of public health. She is pursuing her master’s degree in community health sciences. Ryan Rivet is a writer in the Tulane Office of Publications. Fran Simon is managing editor in the Tulane Office of Publications. Holly Scheib is the owner of and photographer for Four Leaf Clover Photography, based in New Orleans. She is pursuing her master’s degree in international health and development. Madeline Vann (CHS MPH ’98) is a freelance health and medical writer based in Slidell, Louisiana.
H e a lth R ese a r c h N ews
Training Improves Care for Mothers
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ospital education programs can change physician behavior over the long term, according to a new study co-authored by Dean Pierre Buekens. The study, which focused on obstetric care, dramatically reduced rates of uterine bleeding by encouraging doctors to prescribe the drug oxytocin to women just after delivery to contract the uterus and prevent hemorrhaging. The program also resulted in fewer episiotomies, an incision made between the vagina and anus to prevent tearing of the vagina during delivery. Although still widely performed, many studies have shown the procedure is not beneficial. “The goal of this study was to change medical behavior and to create a sustainable intervention. We did that, and we found a profound compliance rate,” said Buekens. “We need strong programs like this to help us change medical behaviors and save more lives.” The study, which was conducted in Argentina and Uruguay, included researchers from the Institute of Clinical Effectiveness and Health Policy, in Buenos Aires; the Research Triangle Institute, North Carolina; the University of North Carolina at Chapel Hill; the World Health Organization; and the Shriver National Institute of Child Health and Human Development. The study’s first author was Dr. Fernando Althabe of the Institute of Clinical Effectiveness
and Health Policy. Buekens said the findings could greatly affect U.S. healthcare. Researchers had opinion leaders from 10 public maternity hospitals attend a five-day workshop on how to develop and carry out guidelines for physicians and midwives based on the best scientific evidence available. The guidelines focused on managing the period after birth of the baby and before expulsion of the placenta. They also stressed limiting the use of episiotomy. Participants also were taught how to communicate what they had learned to their fellow birth attendants. Nine hospitals served as controls for the study. After 18 months, researchers found that oxytocin use increased from 2.1 percent of births before the trial began to 83.6 percent at the 10 instructed hospitals. By comparison, oxytocin use increased from 2.6 percent to 12.3 percent at the control hospitals. Episiotomies decreased from 41.1 percent of births to 29.9 percent at hospitals receiving the staff instruction and increased slightly at control hospitals, from 43.5 percent to 44.5 percent. The hospitals where the staff received the instruction also had a significant reduction in postpartum hemorrhages. After one year, oxytocin use remained high at the hospitals receiving the instruction (73.4 percent) and low in the control hospitals (7.1 percent.). After a year, the episiotomy rate at hospitals receiving the instruction was 28.1 percent and 45.1 percent in the control hospitals. The change in oxytocin prescription being much larger than the change in episiotomy use suggests that adopting a new practice may be easier than eliminating an established practice.
The study was funded by the Global Network for Women’s and Children’s Health Research and the National Institute of Diabetes and Digestive and Kidney Diseases.
“We need strong programs like this to help us change medical behaviors and save more lives.” 2
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Tulane Researchers Study Post-storm Distress Paula Burch-Celentano
Mark VanLandingham
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study of people living in New Orleans when Hurricane Katrina struck has concluded that individuals who lost their homes were five times more likely to have suffered from severe psychological distress a year after the storm than those who didn’t lose their home. The study, co-authored by Mark VanLandingham of Tulane University along with researchers at the University of Michigan, was the first to attempt to survey the mental health of a representative sample of the pre-storm population of the city. “There has been a lot of interest, post-Katrina, about what the impact of the disaster was, both in terms of people’s health and their economic well-being,” says VanLandingham, a demographer and professor of international health and development at the Tulane University School of Public Health and Tropical Medicine. “It’s difficult to answer the question, because a lot of people aren’t here anymore, and the people who can’t return may have suffered the worst consequences. So it’s important - but difficult - to get a representative sample.” The study was carried out during 2006-07. “We had a listing of all the households in New Orleans before the storm,” says VanLandingham. “We stratified it into the areas of the city that got a lot of water, a medium amount of water, and little or no water. The result is a stratified random sample of pre-Katrina residents. We then tried to find them, wherever they were.” The researchers sent each person a questionnaire and a stamped envelope for mail-back. “We used a well-known research instrument that asks a series of questions about what you experienced in the last month,” says VanLandingham. “For example: over the
last 30 days, did you feel nervous, hopeless, restless or fidgety, depressed, or that everything was an effort and worthless?” This is one of several methods used to estimate post-traumatic stress disorder, depression, and other types of psychological distress. “This one has the advantage of being quick, intuitively appealing to people and it seems to have very high validity,” says VanLandingham. The researchers were able to locate about two-thirds of the people they chose on the list, and about 80 percent of those sent back a completed questionnaire or were eventually interviewed in person. In all, the pilot study collected 144 completed surveys. “The sample is small, but the results are surprisingly robust,” says VanLandingham. The survey had three main findings. “The first was that blacks suffered disproportionately more than whites, which may be explained by the fact that flooding was worse for blacks than for whites,” says VanLandingham. “Another was that if you lost your house, your chances of suffering from mental distress was five times higher than if you didn’t lose your house. And the third result was that people age 40-60, the mid-life person who is shouldering most of the responsibility for rebuilding, had nearly three times the chance of suffering mental consequences a year after the storm than our other age groups.” The study is the first of several. “We are now expanding this pilot with a much larger sample,” says VanLandingham. A prime objective of the pilot was to test the survey methodology - would it be possible to contact a representative sample of the New Orleans pre-storm population - even those currently residing in other cities? “We did a reasonable job in tracking people down, so the basic result is yes, this is feasible from a methodological point of view,” says VanLandingham. “Our larger study will replicate this on a much bigger scale and will allow us to speak with more confidence and in more detail about what some of the impacts of Katrina are.”— Arthur Nead
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A View from the I nside
Farley returns from a year at the New York City Health Department
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Paula Burch-Celentano
or the past year, Tom Farley, chair of the community health sciences department, has occupied an unusual position for a Tulane professor: Senior Advisor to the Commissioner of the New York City Department of Health and Mental Hygiene. With a population of over 8 million people and a public hospital network with 11 facilities, the New York City health department is responsible for about twice as many people as live in the state of Louisiana. When he took the position, Farley knew he would be getting on-theground experience in a cutting-edge health department. “The New York City health department has long been an innovator and has been recognized as such across the nation. The whole rest of the country looks to them for leadership. It was very exciting to be in a place where we felt like we were breaking new ground. My job was to be an all-purpose advisor. I was dealing with an incredibly broad range of issues,” recalled Farley. He was involved in the implementation of the health department’s new regulation requiring calorie labeling in fast food restaurants, improving blood pressure management in the 11 city hospitals, and in helping Commissioner Thomas
Tom Farley
some version of the same law, said Farley. Other major initiatives were a comprehensive anti-smoking program that reduced the number of smokers in New York by 300,000; large-scale, free distribution of an NYC-branded condom; and mandatory reporting to the health department of certain laboratory tests for diabetics. Farley returned to Tulane full-time with the observation that students and faculty at schools of public health could all benefit from working in city and state health departments. “You just can’t beat the understanding you get of what people who have the responsibility to save lives do every day,” he acknowledged, adding that this year has also given him material to use in his classes. As an extension of that realization, Farley
“The New York City health department has long been an innovator and has been recognized as such across the nation.” Frieden think through a response to the rise in HIV in young gay men, among other issues. “We talked a lot about other things we could do on foodrelated issues. For example, New York City sells millions of meals a day through schools, prisons, and senior centers. Having healthy food guidelines for [these institutions] could have great potential not just for the people they reach but also by setting standards for other organizations,” he observed. During his tenure in New York, Farley and Frieden coauthored an article for the International Journal of Epidemiology about the major public health initiatives of the New York City health department under Frieden. The initiative that drew perhaps the most national attention was the mandate that no restaurant in New York City could use trans fats in food preparation. Nearly all restaurants are now in compliance with this regulation and many other cities and states have since passed or considered 4
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said he is going to try to shift the focus of his research projects so that the results of his work are more useful to the people who have to set public health policies. “I have a better sense of what sort of research I ought to be doing to give them the information they need. I think we often miss the mark on research. I want to research more policy issues that could be implementable in the real world,” he said. —Madeline Vann
Additional reading: Freiden, T, Bassett, M, Thorpe L, Farley T. Public health in New York City 2002-2007: Confronting the epidemics of the modern era. Int. J. of Epidemiology. 2008: 1 - 12. Published on-line June 2008.
Obesity Impact Growing Worldwide W
>> if current trends continue, the number of overweight individuals will more than double to 2.16 billion by 2030. studies that were published in peer-reviewed journals from January 1990 through August 2007. Overall, the researchers employed 72 national, 22 multi-site, and 14 regional studies from 106 countries, covering approximately 88 percent of the world’s population. The study found that, as of 2005, approximately 23.2 percent of the world’s adult population was overweight and 9.8 percent was obese. Roughly 937 million adults were overweight and 396 million were obese. If current trends continue, the number of overweight individuals will more than double to 2.16 billion by 2030; the number of obese adults will grow to 1.12 billion during the same time period. “One explanation for this finding is that the numbers of over-
weight and obese individuals are expected to increase more rapidly in the developing regions of the world, where the majority of the world’s population resides,” says Kelly, a doctoral candidate at the School of Public Health and Tropical Medicine. According to projections from the study, China will exceed the United States in overweight and obesity prevalence by 2030, making it a particularly relevant worldwide public health challenge. “Most public health initiatives within developing nations focus on infectious disease, but we project that they will need to address problems like diabetes and cardiovascular disease within the next 25 years,” says Kelly. Epidemiologic studies indicate that obesity and being overweight are important risk factors for diabetes, cardiovascular disease, cancer, and premature death. Public health initiatives to reduce the rates of obesity and its complications have been launched in some economically developed countries, according to the researchers. Unfortunately, such programs are scarce in developing countries, where most overweight and obese individuals will reside. The estimates highlight the need for the World Health Organization and governments to support programs that target maintaining a healthy weight, He says. “Primary prevention of these conditions is a better alternative to the treatment of obesity, especially in areas where health care resources are limited,” the authors also say. The research was supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Co-authors include faculty and staff from the department of epidemiology — He; Wenjie Yang, a postdoctoral fellow; Carol Chen, a biostatistician; and Kristi Reynolds, assistant professor of epidemiology. — Keith Brannon and Laura Post Laura Post
aistlines are expanding at such an alarming rate across the globe that, if trends hold, almost 58 percent of the world’s population will be overweight or obese by 2030, according to researchers at the Tulane School of Public Health and Tropical Medicine. Almost one-third of the world is already considered overweight or obese, according to 2005 data examined in “Global Burden of Obesity in 2005 and Projections to 2030,” published in the latest issue of the International Journal of Obesity. Tanika Kelly The research is significant because it is the first to pool systematically the peer-reviewed data from more than 100 countries into one comprehensive global estimate for obesity, according to Jiang He, the Joseph S. Copes chair and professor of epidemiology and medicine at Tulane. Lead author Tanika Kelly and other researchers from the department of epidemiology compiled results from population-based
Tulane awarded two prestigious grants; a third renewed
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n October, the School of Public Health and Tropical Medicine received two important new grants to further research and education. LuAnn White, director of the Tulane Center for Applied Environmental Public Health, will serve as principal investigator for the Tulane study center that will be part of the National Children’s Study. This longitudinal study on children’s health was funded by the National Institutes of Health (NIH). The grant will pro-
vide $14.9 million over five years. Tulane is one of 36 study centers from around the country. The Fogarty International Center, also part of the NIH, awarded Tulane $400,000 to expand global health education through the Tulane Framework for Global Health Program. With Dean Pierre Buekens as the principal investigator, the grant will initiate a new, multidisciplinary global health certificate program for graduate stu-
dents in any Tulane school or department. It will also foster collaboration among faculty. Tulane will also continue its participation in Phase III of the MEASURE evaluation, funded by USAID. This project develops and applies methods for monitoring and evaluating population, health, and HIV/AIDS programs worldwide. Anastasia Gage, associate professor of international health and development, is the principal investigator.
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First-person Experiences Highlight D
awn has barely broken in Lima, Peru, but the Callao Seafood Market is already buzzing with activity. Vendors set up shop in the dark and wholesalers now haggle over prices and pick up standing orders. Professional preparers cut fish in a separate area reserved for this purpose. Most of the products purchased will be sold later in the day in other areas of the city or the surrounding area. Led by a state safety inspector, a group of American graduate students takes a tour of the market, a private world those outside the seafood industry rarely see. Vendors eye the group suspiciously, on guard. Buyers seem wary, avoiding eye contact and assuming an almost belligerent stance. The atmosphere is forbidding, and students gather close. There’s a feeling that anything could happen. For some, this is their first experience in a Latin American country. Even the more seasoned feel a bit intimidated and unsure. As the tour ends, just outside the official market, one student hangs back and strikes up a tentative conversation with a vendor just arriving to market. In Spanish, he tells the vendor the group is from Tulane University and that they have a photographer with them. Suddenly, everything changes. This new-found friend invites the group back inside the official market building. Market regulars, who were just short of menacing a few moments ago, now rally for
Clockwise from top left: Life is intertwined with the Amazon in Belen. Community members use the river for bathing, laundry, transportation, and even trash removal. In the Callao fish market, handling of fish purchased for ceviche is tightly controlled. Professional cutters prepare the fish, working fast and often showing off. This special area is specially designed to drain bleach, seawater, and blood to the street and sewers. Student Carmen Springer studies the mosquito larvae the class collected from homes in Iquitos.
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Peru Summer Course attention and point out the best professional fish cutters for photo opportunities. Affiliation with one of their own has made all the difference to the vendors and buyers, who are eager to meet the Americans and share their culture. Such first-person experiences are a large part of the Peru summer course, taught by Valerie Paz Soldan, research assistant professor of international health and development. Participants make contacts, get up-close and personal with everyday people, and discover the real-life issues that impact health in a developing country. “This really is not a sightseeing course,” says Holly Scheib, course teaching assistant and photographer. “You can be in someone’s home and ask ‘What does health mean?’ and hear first-hand what they think. You get an honest answer.” This is the third year Paz Soldan has conducted the course, which looks at the various issues that impact health in Peru, including geography, development, and politics. The course includes scheduled speakers from nongovernmental organizations, grass-roots groups, research agencies, and the political sphere as well as field trips like the one described above. And it’s not just a one-way experience, with students learning and others teaching. The course provides ample opportunity for students to provide their perspective and for all participants to discuss the implications of what they’ve seen and heard. Scheib points out that the class included students in their 20s through 50s with backgrounds in social work, finance, entomology, and medicine. “It’s the nature of courses at Tulane — people have a variety of perspectives that contribute to the discussion.”
sto r y B y D e e B o l i n g P h otos b y Ho l ly S C HEI B Top: Student Nana Hanson-Hall models the “Ghostbuster-style” mosquito collection machine. Course participants worked with a dengue surveillance team to collect survey data and live mosquito samples. Bottom: The Peru Summer Course Class of 2008 with the drivers of the “combi” they used to tour Lima and Pachacutec. Pictured: Cien Keilty-Lucas, Jessica Friedman, Rebecca Fisher, Sarah Hedges, Nana Hanson-Hall, Laura Van Der Vynckt, and Valerie Paz Soldan. Back row, left to right: Jim Mohler, Patricia Woodall, Carmen Springer, Tina Reynolds, Hilary Demby, (one of the combi workers leaning out of the vehicle), and Heather Kindschy.
New Field Course in Sierra Leone
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n June, Tulane University School of Public Health and Tropical Medicine students participated in a new field course in Kenema, Sierra Leone, conducted by Tulane’s tropical medicine department. The course was integrated into an existing Tulane-affiliated research and capacity-building program in West Africa that focuses on the study and prevention of Lassa fever, a viral hemorrhagic disease endemic to the area. Among other activities, students toured a newly established virology laboratory, met with the Kenema Lassa Outreach Team, and visited a local nongovernmental organization working with street children. Participants were also paired with their Sierra Leonean counterparts studying public health and laboratory science at Kenema’s Eastern Polytechnic Institute.
Pictured: Sheku Bockarie (Eastern Polytechnic student, Red Cross Society administrator), Sister Hawa (Eastern Polytechnic student, hospital sister), Esther Beeson (Tulane student), Katherine Richards (Tulane student), Alpha Morlu (Eastern Polytechnic student, elections commission chairperson), Mary Green (Tulane student), Isata Dumbuya (Eastern Polytechnic student, government hospital nurse and teacher) and Josephine Jamiru (Eastern Polytechnic student). TU L A N E U N I V ERSI TY SC HO OL OF P U B LI C H EA LTH A N D TRO PICA L M EDIC I N E
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igh in the mountains of rural Ecuador, Tulane alumnus David Gaus’ has spent the better part of a decade implementing a model of secondary health care that is focused on quality care and sustainability. The Gaus consults with colleagues on issues hospital he and his colfacing the upstart hospital in Quito. leagues at the Andean Health and Development (AHD) organization built in Pedro Vincente Maldonado is the first financially self-sustaining rural secondary-care hospital in Ecuador. Their
return to Ecuador with a medical degree in hand. Hesburgh continues to play a leading role in the AHD advisory board. Tulane professor emeritus and AHD board member Barnett Cline recalls meeting Gaus when he first came to Tulane. “He wasn’t scheduled to take courses in tropical medicine ‘til spring semester but he came over to meet me, introduced himself and told me right off the bat that what he was going to do with his life was get his medical degree, tropical medicine training, and go back to Ecuador and work there the rest of his life. I was skeptical at the time,” admits Cline, whose research focused on tropical diseases in Africa, South America, and the Far East. But by 1997, Gaus was back in Ecuador, degrees in hand, working with Erik Janowski, a 1992 MPH graduate, and Tom Chiller, a 1994 MD/MPH&TM graduate, in the newly formed AHD.
Filling the Gaps
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Developing a sustainable health care model in rural Ecuador success has been noticed -- they have since been asked by the ministry of health to replicate their model of health care in other hospitals. In the process, Gaus has become not just a family physician but a politician of sorts, gaining the trust of the community, seeking necessary resources, and developing associated programs, such as employer-based health plans – all in pursuit of a long-held dream.
From Accountant to Hospital Administrator
After Gaus completed his undergraduate degree in accounting at Notre Dame in 1984, he went to Ecuador to work with the nonprofit Working Boys Center in Quito, an institution that helps poor families there improve their economic potential. He was so moved by his experience at the mission that he made a personal commitment to return to school for a medical degree so that he could provide care to the people he had come to know. “That experience the first time in Ecuador gave me a passion and a drive and a level of energy that I never had in me,” says Gaus. That’s what kept him going those eleven years at Tulane and in residency at St. Luke’s Hospital in Milwaukee, Wisc., until he moved back to Ecuador in 1997. “Passion is a powerful thing. When you find that, it is not to be understated how powerful that can be,” says Gaus. In a peculiar twist of fate, advice columnist Ann Landers helped find the funding for his pre-med classes at Notre Dame and his combined MD/MPH&TM at Tulane, which he received in 1992. Landers was a friend of former Notre Dame president Fr. Theodore Hesburgh, who supported Gaus’ ambitious determination to 8
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“We started off thinking we were going to do a primary health project but we discovered during the course of those first three years as we opened up a temporary facility that there were a lot of complicated patients coming in that we couldn’t take care of,” says Gaus, recalling the clinic that was a mere 20 square feet in size. “There was nowhere to refer those patients other than the city. We decided we needed to build a small rural hospital that would stand between primary and tertiary care.” “AHD has successfully identified and filled an important gap in local health care,” he says. While many people focus on primary health care in developing countries, it’s important to remember that “the health system has many layers.” AHD faced a steep learning curve, challenged to understand local politics and cultural nuances even as they built the hospital the community needed. “The community convinced us that what they needed was a hospital. We ultimately had to see the problem for ourselves. But in hindsight, it truly was a bottom-up process. They knew all along what they needed. They lived these problems every day,” Gaus says.
Defining the Self-Sustaining Rural Secondary-Care Hospital
“There are certain fundamental principles that we have talked about since the beginning of AHD,” explains Cline. “To provide true quality medical care; to provide access for everyone, not limited to those who have the means; to use skilled management practices, transparency, and accountability in all aspects, especially the financial side; and to involve the community in a very active way, in
financing from the national social security program, contributions from local governments, prepaid health care packages, and self-pay. “What has been accomplished here is a model for organizing and operating a rural hospital, a quality rural hospital, in a developing country, and the potential to adapt that model to the public sector. What we are really trying to do here is create a model of rural secondary health care that is replicable and sustainable and transferable to other parts of the world,” observes Cline.
Of Politics and Public Health
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partnership with key groups in the community. Sustainability has always been an issue. After nine or ten years of hard work, AHD has finally reached that goal of full cost recovery by means of many creative approaches to funding.” In Ecuador there is a network of 4,000 primary health care providers but most hospitals are located in urban areas. According to Gaus, Ecuador dedicates only 2.1% of its national budget to health care, among the lowest proportionate allocation in the Western Hemisphere. Meanwhile, nearly half of people living in rural Ecuador do so in extreme poverty, earning less than US$150 a month. Gaus and his colleagues at AHD looked at the existing models of health care in Ecuador and saw gaps in care. “We noticed that there were three kinds of hospitals. Ministry of Health hospitals struggle with lack of resources and undertrained personnel and lack of equipment. That model wasn’t working. The other option was the missionary model which might provide good quality care but is clearly from the industrialized world and when those resources dry up, the project ends, people go home and the population is left at even greater risk. They don’t address the sustainability option. The other hospital is private, which has all the bells and whistles and adequately trained people, but they only serve paying patients, which are about one third of the population at most,” recounts Gaus. “So our question was, how do you provide quality health care services, 24 hours a day, seven days a week, to a population that has very little resources, in a financially sustainable way?” Ten years after his return to Ecuador his team was doing just that, providing “high-quality health care that never closed, took good care of everybody who came into the place, and in a completely financially sustainable way based on what is available in Ecuador.” But, he laughs, “I could write a book about how not to do it because I have made every mistake humanly possible.” In order to become financially sustainable AHD had to develop a web of payment options. Gaus and his colleagues assume everyone is going to be able to pay and requires some kind of proof that they cannot do so. Costs are then covered through a changing mix of
Gaus highlights three lessons of the many he has learned for other public health and medicine students and professionals seeking to change health care delivery: 1.You can’t do everything! Public health professionals know how many elements, such as good roads and clean water, are important to overall health, but no one can effectively address every possible aspect of health. Focus on what you are good at and what the community needs. 2.Find someone you trust to interpret the local political and cultural nuances. The only thing worse than not having someone to do this is choosing a person who is either bad at it or has his or her own agenda. 3. L isten to the community, because they often already know what they need and what will work. Ultimately, he attributes his success to perseverance. “The more important question is, when we got down there with no money, against all odds and without any clear idea of what we were doing, how did we get it done? There’s a stick-to-it-ive-ness, a perseverance that you need to have,” he says.
Future Steps
The success in Pedro Vincente Maldonado has led to a request from the ministry of health to set up a pilot in a state hospital in La Mana to see if the model is portable. AHD also recognized a lack of family medicine physicians and administrators in Ecuador and has arranged a residency program in Pedro Vincente Maldonado that will provide training for Ecuadoran medical trainees who might be good candidates for rural practices. Ideally some of those local physicians will take on the administrative role Gaus has held building local capacity, while freeing him up to focus on fundraising and teaching, says Cline. Building long-term leadership capacity in Ecuador is a key goal of AHD. q
Additional reading: Gaus D, Herrera D, Heisler M, Cline BL, Richmond J. Making secondary care a primary concern: the rural hospital in Ecuador. Rev Panam Salud Publica. 2008;23(3):212–7.
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Rawson Headlines Spring Commencement M
Karl Grobl
ore than 190 students earned master’s degrees from the School of Public Health and Tropical Medicine at the May 2008 commencement held in Dixon Hall. The school also granted more doctoral degrees this year than ever before. Twenty-six students earned their DrPH, ScD, or PhD. Ian G. Rawson was the commencement speaker. Rawson currently serves as chairman of the board of directors of Hôpital Albert Schweitzer Haiti (HAS) and directs the organization’s finance and development functions in Pittsburgh. The hospital in Haiti was founded in 1954 by Rawson’s mother and stepfather, Larry and Gwen Mellon. Now serving as a model for health care organizations in developing countries, HAS Haiti continues to provide health care and community health and development for the 610-squareIan Rawson, shown with a young patient at the Hôpital Albert mile district in central Haiti. You can see text of his commencement speech Schweitzer in Haiti where he chairs the board of directors, online in the student life section of the school’s website. provided the school’s commencement address in May. The 2008 spring commencement also included the inaugural graduating class earning the bachelor of science degree in public health at Tulane. Seven students received the degree, which was approved in 2003 and implemented in 2005 as a response to a growing health workforce crisis. “We’re faced today with soaring health care costs and a system in crisis,” said Buekens. “Providing an undergraduate public health education will provide our communities with more leaders sensitive to the impact that health issues have on other social and political conditions.” — Ryan Rivet
2008 School of Public Health and Tropical Medicine Awards OUTSTANDING STUDENT LEADERSHIP AWARD Michael Walter Brown, BA OUTSTANDING STUDENT SERVICE AWARD Hirokazu Toiya, BS, MPH TULANE SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE ALUMNI ASSOCIATION STUDENT RECOGNITION AWARD Neal Evan Goldenberg, MD JOHN J. WALSH, MD, AWARD FOR THE OUTSTANDING STUDENT IN THE MD/MPH PROGRAM Diana Nicole Moustoukas, BS Marlow Macht, BS AWARD FOR EXCELLENCE IN BIOSTATISTICS Shih-Feng Weng, MS
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COMMUNITY HEALTH SCIENCES AWARD FOR EXCELLENCE IN NUTRITION Taiya Renae Bach, BS COMMUNITY HEALTH SCIENCES AWARD FOR EXCELLENCE IN HEALTH EDUCATION AND COMMUNICATION Dawn Maria Glapion, BS CERTIFICATES OF RECOGNITION FOR EXCELLENCE IN ENVIRONMENTAL HEALTH SCIENCES Ann Jirapongsuwan, MS Bethany Ketrow, BS David Michael Steinbacher, BS Adam Benjamin Streiffer, BS Amanda Harris Stone, BS
ELIZABETH A. BENNETT AWARD FOR EXCELLENCE IN MATERNAL AND CHILD HEALTH Lauren Elizabeth Futrell, BS, RD, LDN
FRANK W. MACDONALD ENVIRONMENTAL HEALTH SCIENCES OUTSTANDING STUDENT AWARD Bethany Ketrow, BS
CAESAR CORZANTES AWARD FOR EXCELLENCE IN MATERNAL AND CHILD HEALTH Kristin Jeninne Hlubik, BA
WILLIAM R. HARTLEY, ScD, AWARD FOR EXCELLENCE IN ENVIRONMENTAL HEALTH RESEARCH Melissa Jane Owsiany, BS
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DOROTHY R. LEBLANC SCHOLARSHIP AWARD Timir Kumar Paul, MBBS, MPH THE JEFFREY H. EPSTEIN MEMORIAL SCHOLARSHIP AWARD Ashley Monique Weber, BS HEALTH SYSTEMS MANAGEMENT ALUMNI AWARD FOR LEADERSHIP Michael Walter Brown, BA OUTSTANDING MASTER OF MEDICAL MANAGEMENT STUDENT AWARD Steven Bruce Deitelzweig, MD GAYLORD CUMMINS OUTSTANDING MASTER OF PUBLIC HEALTH STUDENT Kevin Timothy Dugan, BS FOSTER MCGAW (A.U.P.H.A.) SCHOLARSHIP William Cameron Bigler, BS JAMES P. GRANT CHILD SURVIVAL AWARD Tierney Jo Davis, BA CARROLL BEHRHORST PRIMARY HEALTH CARE AWARD Meaghan Ann Combs, BA
“The excitement about public health is due to the people that are involved in the program. I really felt like we had a family in the school. They are so excited about [the subject] and that kind of enthusiasm is infectious.” —Amy Collins, BSPH ’08. Collins is from Cut Off, Louisiana. After graduation, she joined Teach for America and ultimately plans to pursue a combined MD/MPH degree.
The Tulane 34 award, presented to 34 graduates from Tulane’s 10 schools and colleges, recognizes students for their exemplary leadership, service, and academic excellence. Named for the year in which the university was founded, the award is among the most coveted university-wide honors bestowed upon students. Pictured here with Dean Jeffery Johnson, public health awardees included (from left to right) Blas Catalani, Tierney Davis, Michael Brown, Amy Collins, and Deepika Sharma.
JACK C. S. LING INTERNATIONAL HEALTH AND DEVELOPMENT STUDENT SERVICE AWARD Deepika Mehrish Sharma, MBA CHARLES C. BASS AWARD FOR THE OUTSTANDING STUDENT IN THE MPH&TM PROGRAM Vidya Mave, MD ERNEST CARROLL FAUST AWARD FOR THE OUTSTANDING STUDENT IN THE MASTER OF SCIENCE IN PUBLIC HEALTH PROGRAM James Clifton Wallace, BA STUDENT GOVERNMENT ASSOCIATION TEACHING EXCELLENCE AWARD Jiang He, MD, PHD DEAN E. ELAINE BOSTON AWARD FOR OUTSTANDING LONG-TERM COMMITMENT TO STUDENT NEEDS Erica B. Geary DELTA OMEGA, ETA CHAPTER AWARD FOR BEST DISSERTATION Emily Susan Jentes
DELTA OMEGA HONORARY PUBLIC HEALTH SOCIETY Ahmed Al-Qasmi Sarah Hope Banner Michael Brown Andrea Cherman Steven Deitelzweig Kristin Hlubik Margaret L. Hudson Emily S. Jentes Ann Jirapongsuwan Jonathan Michael Joliat Helmiati Kadir Kim Kauer Thomas C. Kupiec Yongjua Laosiritaworn Rebekah Leger David Christopher Mire Kasimu Muhetaer Paul Dewayne Murphree David Michael Steinbacher Michael Sweeney Jennifer Juliet Wheeler
OUTSTANDING UNDERGRADUATE STUDENT LEADERSHIP AWARD Mary Catherine White OUTSTANDING UNDERGRADUATE STUDENT SERVICE AWARD Caitrin Elizabeth Hogan OUTSTANDING UNDERGRADUATE PUBLIC HEALTH TEACHING AWARD Dr. Thomas Farley, MD, PHD DEAN’S UNDERGRADUATE SCHOLASTIC AWARD Amy Elizabeth Collins
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hen Lori Stambler Dunsmore first entered public health, she thought she would work overseas. Today, Dunsmore’s career is state-side in her role leading the Rhode Island School for the Deaf. As director of the school, Dunsmore is challenged to align the school’s curriculum with state standards for individuals with disabilities, while juggling a number of reforms, including budget cuts, new graduation requirements, and construction of new facilities. Although she began the master of public health program at Tulane University in 1993, Dunsmore has always felt like she belonged in public health. Her father, who now instructs on the topics of communication and social work at Connecticut State University, was a health sciences professor who worked in the field of public health for many years. “Traveling with my father to countries like Haiti, Mexico, and India, I was inspired by different cultures and communities, and I wanted to work overseas,” said Dunsmore. She came to Tulane to do just that.
“The concepts I learned while getting my MPH have definitely given me a tolerance for everything.” “My experience in earning an MPH was wonderful,” said Dunsmore, who is deaf and was able to complete classes through an interpreter provided by the school. “The assistance I experienced at Tulane was very beneficial, and I never felt as though I was receiving preferential treatment.” She earned her MPH in community health sciences in 1995. Her success did not come without challenge, however, as she initially struggled to find a job after graduation. “I wish that in the future, public health was more accessible for people with 12
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Reprinted with permission of The Providence (R.I.) Journal
Alumna Heads Deaf School Amidst Change
Alumna Lori Dunsmore works with one of the students at the Rhode Island School for the Deaf, where she is director of the school.
disabilities, especially those with linguistical challenges who are interested in that field,” said Dunsmore. Although she did not end up overseas, Dunsmore believes she is at the Rhode Island School for a reason. “What I have learned over the years is that things happen for a reason. If I don’t get what I’m expecting, something will take me down a different road.” In 1995, Dunsmore went to work for Deaf AIDS Action, a non-profit organization that serves the deaf community in Washington, D.C. Supported through Ryan White Grant donations, the organization hired Dunsmore to manage funding. Through this experience, Dunsmore became interested in deaf education and decided to pursue her second master’s degree from Duquesne University (Pittsburg, Penn.) in education administration, while she was the principal at the Scranton School for the Deaf in Scranton, Penn. She later went on to obtain a position as principal for the Washington School for the Deaf in Vancouver, Wash. “After hearing of the changes happening at the Rhode Island School for the Deaf, I believed it was an opportunity to start over,” said Dunsmore, who is the school’s fourth director in six years. Her daily operations include ensuring that the staff is working towards the high standards set for testing of individuals with disabilities, which is a new step forward for the school. In many ways, Dunsmore’s education at Tulane has prepared her well for the task. “The concepts I learned while getting my MPH have definitely given me a high tolerance for everything,” she joked. “I see a lot of similarities in public health and in deaf education– in how to approach obstacles, how to run a business, and how to look at things from other people’s perspectives. All of these skills help me meet the needs of my teachers and students.” After finishing her first year as director at the school, Dunsmore says her biggest accomplishment has been survival amidst the financial concerns and performance requirements. Despite the obstacles, she remains optimistic about the school’s future. “I don’t see the challenge in possibilities. I see the possibility in challenges,” said Dunsmore. — Laura Post
Fulbright Awards Fund Work in Malaysia and Indonesia T wo School of Public Health and Tropical Medicine graduate students have been named winners of the Fulbright U.S. Student Program award. Joseph Kanter, who is pursuing a combined MD/MPH degree at Tulane, is taking a year off between his third and fourth years of medical school to use his Fulbright award. He will be in Kuala Lumpur, Malaysia, for 10 months, working with an organization called the Malaysian AIDS Council. His project will be launching HIV testing, counseling, and treatment programs in clean-needle exchange clinics, in both urban and rural settings. “Three-fourths of the HIV transmission [there] is through dirty needles,” says the Palm Beach, Fla., native who completed his undergraduate degree at Northwestern University in Chicago. The adventure will help him define his career goals, he says. Melinda Ammann, who received a master’s degree in international development from Tulane in December 2007, is heading to Manado, North Sulawesi, Indonesia, as an English teaching assistant at a Catholic high school. The Iowa University graduate who hails from Marshalltown, Iowa, is looking forward to her
Fulbright year on the island, where she plans to initiate publication of a bilingual student newspaper. Much of the purpose of the Fulbright program is to develop cross-cultural relationships, and involvement in the local community is an important part. Ammann hopes the bilingual newspaper will contribute to the sense of community spirit among students at the school, help them develop their language skills in Bahasa Indonesia and English, and foster a free press in Indonesia. “Democracy requires vigilant development of social institutions — like free and critical media — that support genuine and sustainable democracy,” Ammann says. “Organizing a high school student newspaper strikes me as a great way to contribute, however modestly, to Indonesia’s future as a free and democratic society. After all, my students will shape the country’s future.” —Fran Simon
Melissa Johnson
Melanie Amman (above), who graduated with a degree in International Health and Development in 2007, is spending her Fulbright year in Indonesia, working with students at a Catholic high school.
Paula Burch-Celenatano
Paul Kanter (photo right) is pictured with Nilda Rivera, another Fulbright Scholar from Tulane. Kanter, an MD/MPH student, will take a year off from his studies to work with the Malaysian AIDS Council.
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Interns Gain Practical Knowledge in Malaysia
Chris Cotter (second from left) and Sun Yu (third from right) with members of the Malaysian AIDS Council.
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ver the summer, MPH candidates Chris Cotter and Sun Yu completed international internships at the Malaysian AIDS Council (MAC) in Kuala Lumpur, Malaysia. Their mentor, clinical assistant professor of tropical medicine Latha Rajan, has an ongoing collaboration with MAC, which is the same organization that James Kanter will be working with during his Fulbright year. (See article, page 13.)
Yu participated in the internship as a way to pursue her passion for improving the lives of marginalized communities such as orphans, sex workers, and refugees. She worked with one of MAC’s most active partner organizations, the PT Foundation (Pink Triangle Foundation). The PT Foundation is a local nongovernmental organization committed to providing education, prevention, care, and support programs on HIV/AIDS for marginalized communities such as drug users, sex workers, transsexuals, men who have sex with men, and people who live with HIV/AIDS. These groups are often the most difficult to assist because of social discrimination. Before going to Malaysia, Yu says she had not even thought about the Malaysian transsexual population, including transsexual sex workers. “As one can imagine, the transsexual population in Malaysia is marginalized further because of Islam. For instance, if they want to go to mosque, they must go to the male section, even though they truly identify themselves as female. This is a very unique population that needs attention in public health.” Sun plans to explore this topic further in an independent study with Rajan. Cotter worked closely with the Monitoring and Evaluation Division at MAC, where he helped to expand their online reporting database. Cotter also worked on a logical framework and relevant indicators for the newly created priorities recently outlined during the two-year Strategic Plan Workshop. “My experience at MAC helped me to understand some of the challenges that public health professionals face working in an international setting,” says Cotter. “MAC was a stepping board for me to transition from obtaining my MPH to actually being able to apply my knowledge in a practical setting.”
Schweitzer Fellows Inspired by Community Needs
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total of six Tulane University graduate students, including three from the School of Public Health and Tropical Medicine, were selected to participate in the New Orleans Albert Schweitzer Fellowship Program. The Schweitzer Fellowship aims to help underserved or uninsured communities, while simultaneously enhancing the education of health professionals in the area. In a competitive application and interview process, students were selected based on their individual proposals for projects that directly address what the students identified as unmet health and other service needs in New Orleans. New Orleans represents the newest of ten Schweitzer Fellowship Programs across the country, and it was recently established in New Orleans in response to the escalating health needs of the local community. Adenike Onagoruwa, a student in international health and development, will be involved with the Tulane Xavier 14
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National Center of Excellence in Women’s Health and the New Orleans Women’s Health Clinic. She will work to develop an intergenerational health education program for young mothers and their own mothers with a focus on nutrition, reproductive health, and maternal, infant, and child health. Kemi Olaide Orekoya, who is working toward an MPH in maternal and child health, will start an after-school program for female adolescents through the Health and Reproductive Female Initiative Project at a charter school in New Orleans. International health and development student Holly Scheib will work with the Latino Health Access Network to coordinate bilingual training opportunities in parenting and early childhood development for Hispanic parents and child-care providers.
I n M em o ri u m Ktsanes Remembered as a Champion of Public Health
risks for swimmers in Lake Pontchartrain. In 2002, she was honored as a Champion of Public Health by Tulane University. Frances Mather, director of acamemorial service was held at Myra demic information services and a close Clare Rogers Chapel on the Tulane friend of Ktsanes, fondly recounts that University campus on July 12 for Vir“Virginia was always involved in the ginia Kratzer Ktsanes, a longtime Tulane lives of her students, staff and faculty. epidemiologist and former Champion She brought a caring atmosphere to of Public Health. Ktsanes passed away the department and was supportive of on May 5, 2008, at the age of 82, after a the desires, plans and career opportuninearly three-year battle with mantel cell ties of everyone around her. She wrote lymphoma. letters of support, listened carefully to Ktsanes taught for nearly thirty years students and helped them solve their at Tulane University and served as chair problems. Her specialty was the design, of the departments of biostatistics and implementation, and execution of popepidemiology in the late 1980s and ulation surveys in which her students early 1990s. She was a much admired learned to write proposals for surveys and respected professor whose teachthey hoped one day to carry out. Her ing and research covered a wide range of skills made her a much sought-after public health issues including population reviewer of proposals and papers.” Virginia Ktsanes with her grandson, Bon. studies, family planning, teenage pregMather also notes Ktsanes mainnancy, malaria, cancer, HIV, and AIDS. Ktsanes also served as an tained many friendships with former students, from all around the advisor to the World Health Organization, U.S. Peace Corps, and world “who often contacted her to just relate where they were, how U.S. Environmental Protection Agency. In the 1980s, she was a lead they were doing, and thank her for all she had done for them.” investigator in an EPA research project that found significant health —William Ktsanes, son of Virginia Ktsanes
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Hamrick Was a Supporter of MD/MPH Program
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n August, students, colleagues, and friends said goodbye to Joseph Thomas “Tom” Hamrick, former acting dean of the School of Public Health and Tropical Medicine. He passed away on Friday, August 8, 2008 at the M.D. Anderson Cancer Center in Houston, Texas. Hamrick enjoyed a 40-year career at Tulane, and was an emeritus professor of both the School of Medicine and the School of Public Health. He was the founding chairman of the Program in Community Medicine and directed Tulane’s community medicine rotations. He was also instrumental in the development of the MD/MPH program at Tulane. He served as the acting dean of the School of Public Health and Tropical Medicine from 1987 to 1991. During his career, Hamrick also held positions as director of the New Orleans City Health Department and as assistant secretary of the Louisiana Department of Health and Hospitals. According to Tonette Krousel-Wood, associate provost for the health sciences and associate dean for graduate medical education, Hamrick stayed actively involved in the MD/MPH program until very recently, and she applauded his continued efforts to create opportunities for students. “Tom fostered community links with key organizations,and he was a strong supporter of the MD/MPH program.”
Joseph Thomas “Tom” Hamrick
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A l u mni N o tes SERAFINO ADIBAKU CHS MPH 92. Director of Health Services in a rural district of Uganda, managing both public and private sector health service organizations. Also, undertaking clinical trials relating to endemic tropical diseases in the area. KOYA C. ALLEN TRMD MSPH. Awarded an ASPH fellowship to work with the U.S. EPA in the Office of Pesticide Programs, Biopesticide Pollution and Prevention Division. Recent travels have taken Allen to Trinidad, Morocco, and the Sahara Desert. SARA JACENKO ANDRIST INHD MPH. Working at DrTango, developing health care solutions specifically to help reduce health/health care disparities principally in the Hispanic population. PAULA BLOOM HSM MPH, MHA 99. Working for the Department of Education in New Jersey where husband Tanner is in private practice. AARON CHEN EHS MPH 00. Leading the product stewardship and sustainability efforts for the DuPont Clean and Disinfect businesses.
ALICIA DAGGETT INHD MPH 06. Attending medical school at the University of Kansas and expecting to graduate in 2010. DOUG DEGRAAF HSM MPH 80. Currently CEO of a 346-bed hospital with various outpatient and ambulatory services. ROSANNE FARRIS CHS MS 75. Program development and evaluation branch chief, in the Division of Nutrition, Physical Activity and Obesity at the Centers for Disease Control and Prevention. ALISON GOOD, TRMD MPH 02. Occupational safety and health manager for the United States Department of Homeland Security. NINA HALL HSM MD/MPH 99. Practicing general surgery at the Acadiana Surgical Clinic in Opelousas, La. EMILY L. HARRIS CHS MPH 99. Newly appointed as the Arkansas Department of Health program manager for the CDC Community Health Assessment Initiative Project. CATHERINE ANNE (MASON) HOELZER 04. Medical trainer for Christian Mission Aid in Southern Sudan, where her husband Brett also works.
Doug DeGraaf (HSM MPH 80) is CEO of Gadsden Regional Medical Center, a 346-bed hospital in Alabama with various outpatient and ambulatory services.
ERIN HORGAN CHS MPH 07. Managing a research study conducted by the University of California Davis, the goals of which are to develop data collection platforms for longitudinal assessment of change in exposure to environmental contaminants. TU VAN HUYNH CHS MPH 98. Director of the Tay Ninh Center of Reproductive Health in Vietnam. JANE PARKER HSM MPH 93. Director of the Institute for Psychosocial Health at the Tulane School of Social Work. Parker is also collaborating with the SPHTM Dept. of Environmental Health Sciences on curriculum dealing with the psychosocial aspects of disaster in its disaster management programs. JESSICA POLLAK KAHN INHD MPH 96. Project officer/health policy analyst at the U.S. Centers for Medicare & Medicaid Services, managing several large grant programs awarded to states to improve quality and access to comprehensive health care for Medicaid beneficiaries and the uninsured. JENNIFER RANKIN HSM MHA 99. Completing dual degree (PhD/ MPH) in Public Health Informatics at The University of Texas Health Science Center at Houston Schools of Health Information Sciences and Public Health. SRIKRISHNA SULGODU RAMACHANDRA INHD MPH 08. Assistant professor at the newly incorporated Indian Institute of Public Health, part of the Public Health Foundation of India. NEILESH SHELAT, INHD MPH. Accepted a position as a USAID Field Program Officer based in a province of Ghazni, Afghanistan and assigned to a NATO/ U.S.-led provincial reconstruction team. Shelat will oversee many of USAID’s development projects and experience the realities of civilmilitary affairs in a war-zone. AMY STARKE INHD MPH. Studying to be a midwife and family nurse practitioner at the University of Michigan while working part time as a nurse.
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CHRISTINA BEACH THIELST HSM MHA 89. New Fellow in the American College of Healthcare Executives and served as editor on a collaborative effort book release in 2007. KELLY ANN YOTEBIENG INHD MPH. Relocated to Yaounde, Cameroon, to take a position as a business development manager with Catholic Relief Services. Yotenbieng is responsible for developing quality project proposals and media materials with the country program’s project managers, as well as assuring sound and high-quality monitoring and evaluation systems for each of the projects.
Key to abbreviations: BIOS: biostatistics, CHS: community health sciences, ENHS: environmental health sciences, EPID: epidemiology, HSM: health systems management,
Jeffrey Johnson
JEAN YOUNG TRMD MPH 97. Medical superintendent at the Saboba Medical Centre in Saboba, Ghana. Srikrishna Sulgodu Ramachandra (INHD MPH 08), shown here at graduation with his family, is an assistant professor with at the newly incorporated Indian Institute of Public Health in Hyderabad, part of the Public Health Foundation of India.
INHD: international health and development, TRMD: tropical medicine, HF: Humphrey Fellow
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Faculty receive Teaching Scholar Awards
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Rebecca Hall
Rebecca Hall
Assaf Abdelghani (left), professor of environmental health sciences, and Laura Murphy (right), clinical assistant professor of international health and development, received 2008 Teaching Scholar Awards at the annual faculty retreat, held in October. Both are shown with Dean Pierre Buekens, who presented the awards.
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Baby Boom Among MD/MPH Students
We n eed you! Donn Young
MDMPH students recently experienced a baby boom in their department and are pleased to announce the arrival of their little ones. Back row (left to right): Kathryn Kerisit (EPID), pregnant with baby Elise Patricia; Heidi Klein (HSMG) with baby Olivia; Amanda Goertz (TM), due in October 2008; Diego and Anna Lara (TM) with baby Bayona Elizabeth; Amy and Marlow Macht (TM) with baby Elijah William; Susan Brim (TM), pregnant with baby Marikit Zenaida; and Briana Zachary (TM) with baby Grace Hannah. In center: John Roberts (INHL) and Elizabeth Overweg with baby Sofia Erika Veronica Roberts. (Not pictured: Rachel Littrell (TM) and baby Lillian Faye Littrell)
Global Health
Office of the Dean School of Public Health and Tropical Medicine Tulane University 1440 Canal St, Ste. 2430, TW-13 New Orleans, LA 70112 www.sph.tulane.edu
A Global Commitment to Public Health
Alumni Survey
The school is conducting an alumni survey as part of the school self-evaluation process for re-accreditation – and your feedback is critical to our ongoing efforts to educate and help develop our next generation of public health leaders. Please log on and complete the survey. www.sph.tulane.edu/alumni