Global health through the lens of a social scientist at UW

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This story was originally written by the Badger Herald.

When the deadly Ebola epidemic broke out in West Africa in 2014, the World Health Organization declared a global health emergency. Groups of global health experts marched to the frontline, a University of Wisconsin scientist was one of them.

Sarah Paige, assistant scientist at UW’s Global Health Institute and advocate for global health, responded to United States Agency for International Development’s call for help. She spearheaded an effort to create a research proposal, which later became the Ebola Survivor Corps, a community outreach program to address the outbreak.

Ebola Survivor Corps

The project was crowdfunded through Indiegogo. Together with scientists from Seattle, Madison and New Orleans, Paige raised $15,000 on the site as well as other diversified sources of fundraising. That’s when the situation got real for her, Paige said.

“This sort of really large initiative puts the pressure on us to make something real,” Paige said. “Because we have so much money that we raised, we need to do something real with it.”

After building a solid financial foundation, Paige’s team recruited five Ebola survivors from Sierra Leone to work in a large but under-populated local district. The survivors worked on community health outreach and mobilization by hosting community meetings, visiting local schools and educating district leaders on the importance of community health practices, Paige said.

During a measles outbreak in January and February, the survivors worked with the health sector to mobilize people towards a vaccination campaign and teach them health knowledge, from hand washing to the difference between measles and rubella, Paige said.

“They’re doing really active community health education on very basic public health practices,” Paige said. “Because they’re project managers in the health sector, they’re also able to be responding to outbreaks.”

Survivors with the experience of being sick and recovering have a more unique and relatable approach to providing health education and inspire other people to be healthy, Paige said.

The project went full force in January, but Paige said she is not currently looking to expand to other districts because she wants to refine the work first and make it a really comprehensive approach. She wants to make sure the survivors corp she is working with right now have the literacy to effectively report the situations of the communities.

“We’re working on the tweaking as we go,” Paige said. “How can we leverage the experience of survivors to make sure this doesn’t happen again, to elevate survivors and their stories, to address some of the stigma and social trauma around the types of illness and then also to be a partner and to work with the survivors and providing community outreach.”

Global health through the lens of social scientist

The Ebola Survivor Corps is only one of Paige’s many endeavors to improve the state of global health. Since her undergraduate years she said she wanted to embark on a career where she can care for people and humanity.

After a year working in a hospital, Paige said she realized being a doctor is the last thing she wanted to do, so she spent time switching jobs, trying to see what the world is really like. She found her passion for global health during her travels.

“I really appreciate being in another part of the world, and I wanted to tie that interest with global health,” Paige said.

After getting her master’s of public health degree from John Hopkins University and doctoral degree in health geography at University of Washington, Paige came to University of Wisconsin to work with the Global Health Institute and pursue a postdoctoral degree, studying the interaction between humans and animals in terms of disease transmission.

Besides Ebola Survivor Corps, Paige also works on multiple other projects, including UW’s Kibale EcoHealth Project, a long-term investigation that taps into the health and ecology in Kibale National Park, Uganda. She studies the communities that live on the periphery of the park, focusing on the health of people and livestock there.

Paige said her focus is on working with communities that are on the frontlines of potential spillover activities, communities that are most vulnerable and most likely to be the places for disease pop up.

Paige said media often portrays these communities in a negative light, and other NGOs give condescending messages to communities with the problem, which made her feel it was time for her to act.

“I’m a social scientist with expertise in community engagement, community understanding, and I felt I have something to offer,” Paige said. “If we want to really prioritize health system around the world, community outreach and engagement within those health systems is a must, that’s the foundation to a strong health sector.”

This story was published on May 2, 2016 by Xiani Zhong.

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Sumudu Atapattu examines links between human rights and climate change

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This story was originally published by the University of Wisconsin Law School on February 23, 2016. 

Before discussing her new book, Sumudu Atapattu wants to make one thing clear: human activity is causing the planet to heat up.

“We can no longer dispute it,” she says. “Scientists agree, and nearly 200 nations endorsing the Paris Accord agree: climate change is here, and it’s now, and we need to take strong action to address it.”

That settled, Atapattu says she wrote “Human Rights Approaches to Climate Change: Challenges and Opportunities” to shift the emphasis of the climate debate to people and their rights. The book, published in October by Routledge, looks to international law for answers to hard questions about mitigating climate change and preparing people for its impacts.

Atapattu teaches environmental law at University of Wisconsin Law School, directs the school’s Research Centers, and is a faculty affiliate of the Nelson Institute for Environmental Studies. She is also an advisory board member at the Global Health Institute at UW-Madison. She has long argued that climate change threatens fundamental human rights, such as the right to clean water and healthy food, the right to a safe place to live, even the right to life itself — and that the world’s poor are hardest hit.

“We’re talking about millions who are in immediate danger, or who will eventually be displaced, by rising sea levels, extreme weather events or resource scarcity,” she says. “We have a duty to protect their rights.”

To illustrate, she describes the plight of the impoverished village of Kivalina, Alaska, located on a fragile island above the Arctic Circle. Record-high ocean temperatures have caused the sea ice that surrounds the low-lying island to thin. With sea levels rising and its protective ice melting, the island is eroding at an alarming rate. Experts predict Kivalina will be completely submerged in ten years.

“We’re talking about millions
who are in immediate danger,
or who will eventually be
displaced, by rising sea levels,
extreme weather events or
resource scarcity. We have
a duty to protect their rights.”

“When an entire community has to move due to climate change, what rights do its citizens have? Do they get to decide where and when they go? Does the new place have access to basic resources?” Atapattu asks.

Her questions are rhetorical: according to Atapattu, the U.S. is legally bound to help relocate Kivalina residents to a safer place, and in doing so, it must employ a broad human rights framework. But so far, the funds necessary for relocation haven’t been allocated, and there’s no government mechanism in place to assist in a move.

Atapattu attended a portion of the historic United Nations Conference on Climate Change in Parislate last year, when 195 countries adopted a landmark global climate deal. One of the main developments coming out of the conference was the shared commitment to limit warming to no more than 2 degrees Celsius above pre-industrial levels, with a longer-term goal of holding temperature increases less than 1.5 degrees. For some countries, a 1.5 degree temperature goal will mean sharp cuts in emissions; for others, particularly those living on small island states, it is a matter of survival.

Atapattu left Paris with a sense of guarded optimism. “If we can’t stop sea levels from rising, we can expect a huge humanitarian catastrophe with regard to low-lying small island states. Their citizens stand to lose everything, including the land their families have lived on for generations. That is in spite of their minimal contribution to the problem,” she says.

Explicit references to human rights, which appeared in early drafts of the Paris agreement, were removed from the document’s legally binding section in its final draft. While that omission angered some climate activists, Atapattu says that nations’ responsibility to uphold and implement international human rights standards was never in doubt.

“It was disappointing to lose the human rights language, but not the end of the world,” she says. “It’s important to remember that states have already accepted human rights obligations under international law, with or without explicit references to human rights in the Paris Accord.”

Students in Atapattu’s environmental law classes learn about those existing obligations as they apply to climate change. Ultimately, she hopes to bring her students, as future lawyers and scholars, to the table to work toward climate change solutions, along with scientists and policy makers, economists, health workers, business people, and others.

“We need more integrated approaches to addressing the problem,” she says. “Finally recognizing all the links — between climate justice and the economy, national security, agriculture and public health — is a good start.”

This story was written by Tammy Kempfert

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UW-Madison at forefront of innovation in nuclear energy

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This article first appeared on www.engr.wisc.edu on April 9, 2016.

For countries to sharply reduce carbon emissions while also meeting the increasing demand for electrical energy, it’s widely recognized that nuclear power needs to be part of the solution.

Next-generation advanced nuclear reactors promise to compete economically with natural gas. These advanced reactor technologies are safer and more efficient than the conventional light water reactors operating today.

However, for advanced nuclear reactors to make an impact on cutting carbon emissions fast enough to stem climate change, the advanced nuclear sector and government need to work together to develop and deploy the next generation of reactors at a more rapid pace, according to University of Wisconsin-Madison Engineering Physics Assistant Professor Raluca Scarlat.

“We need plans quickly for new reactors—and quickly is not a word that’s been used in nuclear,” Scarlat says. “In order to change that, we need a lot of bright minds coming into this field. We need a lot of innovation.”

To help accelerate innovation in advanced nuclear and highlight nuclear’s role in addressing climate change, the think tank Third Way and the Idaho National Laboratory partnered with Argonne National Laboratory and Oak Ridge National Laboratory to host a first-of-its-kindadvanced nuclear summit and showcase in Washington, D.C., on January 27, 2016.

During the showcase portion of the event, Scarlat, along with research collaborators from the University of California-Berkeley and MIT, gave a presentation on the innovative fluoride-salt-cooled high-temperature reactor (FHR) concept that they’re working on developing. FHR is an advanced reactor design that uses a solid fuel and molten (liquid) salt as a coolant.

From left: Distinguished Research Professor Kumar Sridharan, Assistant Professor Raluca Scarlat and Research Professor Mark Anderson next to a storage container for high-temperature salt. Photo credit: Gregory Vershbow
From left: Distinguished Research Professor Kumar Sridharan, Assistant Professor Raluca Scarlat and Research Professor Mark Anderson, all principle investigators in the UW-Madison engineering physics department researching molten salts, standing next to a storage container for high-temperature salt. Photo credit: Gregory Vershbow

Several startup companies also presented their novel reactor concepts in the showcase, and Scarlat says it was very exciting to see the progress being made by nuclear entrepreneurs in this area.

Scarlat says companies like TerraPower, which was founded by Bill Gates, are helping drive innovation in advanced nuclear technology. TerraPower, which is working on developing a molten chloride salt reactor, is part of a public-private partnership that was recently awarded up to $40 million from the U.S. Department of Energy to develop the technology.

And when these growing companies want to recruit top talent, they look to UW-Madison. For example, Brian Kelleher, who earned his PhD at UW-Madison working on the FHR project under Engineering Physics Distinguished Research Professor Kumar Sridharan, is now working at TerraPower.

“This recruiting shows we’re effectively training our students at UW-Madison to work on these advanced nuclear technologies, and that is feeding this new resurgence of innovation in nuclear,” Scarlat says.

To enhance students’ educational experience, Scarlat reached out to a number of molten salt reactor companies to see if they would be interested in serving as advisors for student design teams in NEEP 412: Nuclear Reactor Design. Scarlat says the response from the companies was tremendous, with six agreeing to serve as team advisors. “By building connections with these companies, we’re also reinforcing the fact that we’re training students in this area and companies can recruit talented engineering grads from us,” she says.

In addition to the innovative FHR research and training students, Scarlat says UW-Madison’s unique capabilities for handling and studying molten salts containing beryllium make the university a leader in advanced nuclear.

Because beryllium is highly toxic, it’s difficult to build facilities that can handle these kinds of high-temperature salts. UW-Madison is the only university in the country with the safety procedures in place to handle and purify beryllium fluoride salts and with faculty members who have experimental expertise with these molten salts.

“Our experimental facilities are quite unique at UW-Madison, and we can assist nuclear companies by doing measurements that are specific to their reactor designs,” Scarlat says.

Written by Adam Malecek

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18th annual Wisconsin Idea Fellowships awarded to nine student projects

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WIF Announcements3

The 18th year of the Wisconsin Idea Fellowships will feature nine unique undergraduate projects at home and across the world: The closest within 500 feet of campus. The furthest over 7,700 miles away.

The projects, which are all rooted in the concept of addressing needs identified by community partners, range in topic from public health, to agriculture, college-preparedness mentoring, poverty and more. A total of 15 UW-Madison students are part of this year’s projects, sponsored by the Morgridge Center for Public Service.

Wisconsin Idea Fellowships (WIF) are awarded annually to UW-Madison undergraduate projects working to solve issues identified by local or global communities. Fellowships are awarded to semester-long or year-long projects designed by an undergraduate student or group of students in collaboration with a community organization and a UW-Madison faculty or staff member.

The WIF selection process is highly competitive, with successful projects receiving both logistical and financial support—up to $7,000. Some projects will begin this summer, and some may last through next May.

The 2016-17 fellowships also feature the brand new Michael Thornton and Nora Medina Social Innovation Award, a special honor made possible by a generous endowment fund for WIF projects targeting the opportunity gap in Madison. Michael Thornton, a professor in the Department of Afro-American Studies, is also a past director of the Morgridge Center.

Some of the undergraduate winners who are featured below are also global health students.

2016-17 Wisconsin Idea Fellowships:

Harnessing Community Ownership and Engagement to Reduce Local Poverty (Dane, Jefferson, Waukesha counties)

Students: Jarjeh Fang (Political Science and Neurobiology) & Swetha Saseedhar (Biology, French and Global Health)
Faculty advisor: Pamela Herd
Community Partner: Community Action Coalition of South Central, WI

This project seeks to strengthen the Community Action Coalition of South Central Wisconsin’s (CACSW) programs and services to reduce poverty in Dane, Waukesha, and Jefferson counties. Using the outcomes of a student-driven Community Needs Assessment (CNA), students will develop and implement an action plan that addresses the underlying pathways and mechanisms of poverty, and improves CACSW’s ability to address community needs, and increases community engagement with and ownership of programs and services.

Empowerment of Coastal Communities Through Permanent Water Quality Monitors (Manabí Province, Ecuador)

Students: Amelia Rossa (Conservation Biology Geography), Joshua Kalman (Environmental Studies, Conservation Biology), Caden Lambie (Biology, Spanish, Global Helath)
Faculty advisor: Catherine Woodward
Community Partner:
Ceiba Foundation

In Manabí province, a coastal region of Ecuador, Giardia, Cholera, amoebic dysentery, and dengue are common where water quality is often poor. Working alongside the Ceiba Foundation for Tropical Conservation, students will train others in water quality monitoring techniques, establish permanent water quality monitoring sites, collect water quality data and compose informational materials for community dissemination.

This story was first run on the Morgridge site on April 21, 2016.

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Advancing Palliative Care

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This article appears in Quarterly magazine.

Two of the world’s leading medical journals recently turned to the University of Wisconsin School of Medicine and Public Health’s (SMPH) palliative-care leaders to frame important end-of-life care issues.

Toby Campbell, MD, MSCI (PG ’04), went first, writing an editorial for the Journal of the American Medical Association in November 2015 about how his views have evolved as he has learned from patients. He explains that the “bucket list” approach to life’s end can exhaust everyone.

“Now I understand that fighting for a moment of ‘normal,’ for a minute that doesn’t matter, is relevant and valuable,’’ wrote Campbell, an SMPH assistant professor of medicine. “I’ve since handwritten a prescription for ‘a cancer-free weekend.’ (A clinician) could be more like a coach giving permission to call a time out, during life’s two-minute drill, for a moment of normal amidst the noise of a life at its end.”

His mentor, James Cleary, MD, an SMPH associate professor of medicine, was asked to write an editorial for The Lancet in February 2016, commenting on the fact that failed pain policies mean people across Asia and Africa continue to die in pain, unable to access drugs the World Health Organization considers essential.

James Cleary, MD is also on the Advisory Board for the University of Wisconsin Global Health Institute.

Palliative care barely existed at UW-Madison when Cleary arrived from Australia 22 years ago to research pain relief in cancer care at the UW Carbone Cancer Center (UWCCC).

“Dr. Paul Carbone asked me if I’d be interested in starting a palliative-care program,’’ says Cleary, who did so and became the program’s first clinical director. Having since grown into a team of six physicians, an advanced practice nurse, pharmacist, social worker, psychologist and chaplain, the Palliative Care Program provides inpatient and outpatient care for patients who have any serious disease, compared to some programs that focus solely on cancer.

Along the way, Cleary and Campbell — both UWCCC members — have trained the next generation of medical students, residents and fellows. Their core program for SMPH third-year students consistently ranks among the most highly rated courses.

James Cleary and Toby Campbell

James Cleary, MD (left), and Toby Campbell, MD, MSCI (PG ’04), have helped change the way doctors talk with patients about serious illnesses and approach end-of-life care.

Each year since 2009, UW Hospital and Clinics has used Campbell’s “WeTALK” program to train new residents to communicate with patients about serious illnesses. In 2014, the SMPH Department of Medicine employed WeTALK to train more than 600 faculty and staff members, and the school’s Department of Family Medicine and Community Health plans to do the same in 2016.

This year, Campbell and his team trained 29 acute care surgeons to use an innovative communication tool he designed with Gretchen Schwarze, MD, an associate professor in the SMPH’s Department of Surgery, Division of Vascular Surgery, called Best Case/Worst Case, for high-risk shared decision making. Campbell leads a “PalliTALK” workshop for palliative care fellows from across the nation.

“The UW is at the forefront of improving doctor-patient communications across the enterprise,’’ notes Cleary. “We have changed the way doctors talk to patients about serious illnesses.”

Still, the two physician-researchers agree that much more needs to be done. Campbell cites a recent New England Journal of Medicine study showing that a large majority of people with incurable cancer don’t understand that their disease will likely kill them. They’ve found similar numbers in research about their own cancer patients.

“Patients are told this news, but not in a way that registers,’’ Campbell says. “It’s because we speak in what I call ‘onco-babble,’ treatment-focused talk that often leaves no space for patients to grasp the meaning of the oncologist’s words about an incurable disease.”

Rather than rush into treatment discussions before their diagnosis has sunk in, Campbell has proposed a method that facilitates a prognosis discussion between providers and patients so they can work through the process with their physicians. He also researches whether such communication training makes a difference in patient care. His results suggest it does.

“Can you teach empathy?” Campbell asks. “Yes, you can teach people to see and respond skillfully to human suffering and distress. When we teach WeTALK workshops, the participants emerge able to communicate differently and more effectively compared to the day before.”

 

Increasing those the Palliative Care Program can train, in 2015, for the first time, it participated in the national match for fellows, filling all four of its fellowship slots. Campbell succeeded Cleary as the chief of palliative care in 2011, giving Cleary more time to focus on helping improve pain control in the United States and around the world.

Along with leading the Carbone Cancer Center’s Pain and Policy Studies Group and serving as a member of the UW-Madison Global Health Initiative, Cleary is a leader of the international Global Opioid Policy Initiative and a member of the Lancet Commission for Palliative Care and Pain Relief. He is concerned that a backlash to opioid addiction in the United States is leading to restricted access to that class of medication for people with cancer and other serious illnesses.

“Our goal is to ensure access to those who need opioids for medical purposes while reducing the risk of misuse and diversion,” Cleary explains.

Despite these concerns, public awareness about palliative care has never been more keen. Cleary and Campbell were featured in two documentaries, which aired on PBS, addressing communication at the end of life called “Consider the Conversation.” A third documentary is being planned. Additionally, the best-selling books Being Mortal, by Atul Gawande, MD, MPH, and When Breath Becomes Air, by Paul Kalanithi, MD, have increased public dialogue.

Cleary says he’s seen growing appreciation over two decades for the idea that health care must focus not only on living longer, but also on improving quality of life. Change is occurring, albeit slowly.

“It’s like being aboard the Titanic,’’ Cleary shares. “The crew in the helm, and even the people playing in the band, know we have to change direction. Unlike the Titanic, the ship is turning, but it takes time.”

By Susan Lampert Smith

Date Published: March 16, 2016

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