Making a better flip-flop to overcome illiteracy and disease



Contact: Tony Goldberg, associate director for research, Global Health Institute; professor of epidemiology, School of Veterinary Medicine, 608-890-2618 or

In many parts of the world, a good share of the population wears flip-flops. In America, the candy-colored sandals are a ubiquitous herald of summer. In rural Uganda, kids wear them, adult men and moms wear them whether they’re bopping around the compound, working in the fields or getting water.

For Dr. Tony Goldberg and postdoctoral scholar Sarah Paige at the University of Wisconsin-Madison, flip-flops present a challenge and an opportunity to overcome illiteracy and better combat helminths, the parasitic worms that can burrow into bare feet and cause gastrointestinal illness. Thanks to a recent $100,000 Grand Challenges Exploration grant from the Bill & Melinda Gates Foundation, they’re developing the holoflop™ that protects feet from soil-borne parasites and encourages people to wear them.

The holoflop™ is a flip-flop with a hologram attached that will show the benefits of wearing sandals to people who cannot read, says Goldberg, associate director for research at the UW-Madison’s Global Health Institute (GHI), professor of epidemiology in the School of Veterinary Medicine and director of the Kibale EcoHealth Project. Paige, a medical geographer, works with Goldberg at the university and has been part of the Kibale project since its inception.

Illiteracy is a substantial road block worldwide as public health practitioners try to disseminate information about everything from medication to child vaccinations. With holoflops™, Paige and Goldberg will tap into people’s knowledge of symbols, graphics, pictures and images to deliver the health message. “We are being educated by local people on symbolism that will be relevant to them,” Paige says.

“Grand Challenges Explorations is designed to foster the most innovative ideas to save the lives of the world’s poorest people,” says Chris Wilson, director of the Gates Foundation’s Discovery and Trans

lational Sciences team.

Paige and Goldberg’s project, “Flip-Flops and Holograms for Disrupting Helminth Transmission,” was among 81 projects selected for initial Gates Foundation funding from more than 2,700 proposals. The projects address a wide range of issues including using social data for social good, designing the next generation of condom, helping women farmers in the developing world, finding new interventions for neglected diseases and bringing together human and animal health for new solutions.

The science behind holoflops™  draws from Goldberg’s decade of quantitative work on how diseases are transferred between wildlife and humans in and around Kibale National Park.

Soil-transmitted helminth infections are among the most common

infections in the world. People and animals shed helminth eggs in feces into the soil, where the worms grow and later infect humans. In Uganda, helminths are abundant in dirt compounds used by humans and animals.

Goldberg - insert

“We’ve been good epidemiologists,” Goldberg says. “We spent years documenting that disease could be transferred between animals and humans and understanding the risk factors that put people in contact with animals, why they might get diseases, what diseases they might be getting, where it’s happening and the effect it’s having on the people and the animals.”

With holoflopos ™, the scientists move beyond generating data to helping rural people avoid disease.

Paige grounds the project in an understanding of Uganda’s complex social systems. All societies have hierarchies, she says. Introducing a new project or product can exacerbate inequities, leaving the poor even more vulnerable. Introducing new technology too quickly can also scare people away from using it.

“Flip-flops are something they are already familiar with,” she says. “Using them maintains the status quo.”

Goldberg and Paige are working with a graphic designer and looking for a shoe company. Focus groups in Uganda will help determine the best images for the hologram and colors for the sandals. The researchers will measure whether holoflops™ reduce disease incidence and how they are accepted by the community. “We will also just be popping in on participating households to see if folks are wearing the holoflops and who is wearing them, as well as how well they are holding up,” Paige says.

Goldberg is optimistic, in part because the idea is simple. “I’m excited that the holoflop™ could become widely used to improve health,” he says.

The Global Health Institute, supported by public and private funds, is dedicated to addressing the multi-layered causes of health and disease and discovering sustainable strategies to improve well-being. GHI fosters collaborations that expand the traditional, medical responses to international health crises and include environmental, economic, political and public health strategies.

Nov. 25, 2013 | by Ann Grauvogl

Global is Local: DeMarco Bowen


“It’s one thing to read about health problems in literature, but another entirely to see them on the ground. (The field experience in Uganda) is what set it in stone. I want to be part of this.”

-DeMarco Bowen, ‘12.


As soon as DeMarco Bowen was accepted into medical school at the University of Wisconsin-Madison, he immediately applied to the Global Health Graduate Certificate program offered through the Global Health Institute (GHI).

He had already been involved with global health as a UW-Madison undergraduate, completing a field course experience in Uganda. His project was a directed study in sociology, comparing the epidemiology of HIV in Uganda and South Africa, and he was fascinated with the virology of HIV.DeMarco Bowen

In the 1980s, Uganda started with one of the highest rates of HIV, and South African had almost no problems, Bowen said. Uganda’s then newly elected president, Yoweri Museveni, took the initiative to reduce any stigma attached to HIV and began an educational strategy based on abstinence, monogamy, condom use and, more recently, empowerment. South Africa denied HIV was a problem.

Today, Uganda has the lowest HIV rate in sub-Saharan Africa, and nearly one in three South Africans is infected.

The undergraduate Global Health Certificate had not been launched when Bowen, who’s just completed his first year of medical school, joined the GHI field course as an undergraduate student. So he was especially interested in finishing the graduate certificate. To him, the certificate will help supplement his MD and MPH education, and it will help give him the tools to work in a global health field. The GHI electives introduce students to health care in diverse communities, he said. “They really understand that local is part of global, under the right context.”

This summer, Bowen visited Ethiopia for graduate field work, where he studied the prevalence of HIV and Hepatitis B and C in the emergency department in an Addis Ababa hospital.

A Milwaukee native, Bowen hadn’t traveled out of the Midwest until a winter break college trip to California. He likes to travel and wants to integrate it into his life. He said he quickly learned to appreciate the Ugandan culture, which welcomed him. “When you don’t have a lot of resources, you have to rely on each other,” he said, speculating there may be an inverse correlation between resources and a rich social structure.

By Ann Grauvogl

Sept 23, 2013

Tweets contribute to animal, human well-being


“today in creepy things: found a dead crow in the garden. the other crows are mourning/freaking out w/cawing”

“Just saw a dead deer on the side of the street L”

With Tweets like these, ordinary citizens are helping fill a gap to help scientists better understand wildlife health in Wisconsin.

By collecting information from sources as varied as Tweets and news stories to citizen scientist observations and more rigorously collected government data, the Wildlife Data Integration Network (WDIN) is creating a more complete and immediate picture of wildlife health that could signal the early stages of emerging, significant threats to human and animal health.

Traditional government reports often focus only on federal or state lands and certain species, providing an in-depth look at only part of the wildlife disease puzzle, said Megan Hines, technical manager for WDIN at the University of Wisconsin-Madison School of Veterinary Medicine. The reports are often only released quarterly and not in formats that meet the needs of most researchers.

“We’re trying to cast a broader net and increase the speed at which this information can be accessed,” Hines said.

Hines quote, WDIN

WDIN’s “Emerging Disease Detection through Novel Wildlife Health Information Channels” was among eight projects that received one of the Global Health Institute’s inaugural seed grants in 2011. The grants encourage interdisciplinary, multi-faceted approaches to tackle the root problems of human health. WDIN’s collaborators come from UW’s Department of Computer Sciences, the Nelson Institute for Environmental Studies, Life Sciences Communication and the School of Veterinary Medicine and the US Geological Survey National Wildlife Health Center.

The grant allowed WDIN to expand its outreach to more fully engage and retain citizen scientists through the Wildlife Health Event Reporter (WHER). WDIN worked with computer science professor Xiaojin Zhu and graduate student Junming Su to monitor Twitter for mentions of wildlife health events, and they hope to refine and expand the process to other social media sites and information sources.

WDIN embraces the concept of “one health” that includes the well being of animals and humans. There are many close connections between animals and humans, and disease transmission is an important component of these interactions, Victoria Szewczyk, WDIN administrative manager, said, citing several examples:

  • More than 75 percent of the emerging infectious diseases affecting humans have wildlife origins. Diseases that are transmitted from animals to humans and vice versa are referred to as zoonotic diseases. Rabies, West Nile virus and avian influenza (bird flu) are among the wildlife diseases that can infect humans and domestic animals as well.
  • Humans increasingly encroach on wild places, and habitats begin to overlap, increasing human exposure to wildlife and disease. Animals once restricted to rural environments are now visible in urban backyards.
  • We live with animals, raise animals for production, and simple human-animal interactions can contribute to spread of disease. Consumption of animals has led to devastating human diseases around the globe such as Mad Cow disease and the spread of the Ebola virus.
  • (e.g., Mad Cow disease and Ebola virus spread from eating primates in African countries).

“It’s very easy for these viruses to move from one critter to another, including us,” Szewczyk said. WDIN is collecting and sharing this data in the effort to protect the health of all.

While they recognize citizen reports will over- and under-report some species, cross-referencing observations with other more rigorously collected data and monitoring reports can help establish a baseline of normal dead-animal activity, so scientists can identify abnormal patterns in the future, Hines said. A group on the East Coast, for example, observed a large uptick in dead seabirds but couldn’t define the extent of the problem.  Tufts University and their coastal partners agreed to post sightings to WHER to capture the observations in a central location.Picture 18

Reporting data from across a variety of channels will help scientists understand what is happening now and predict what could happen in terms of animal and human disease, Szewczyk said, WDIN data will allow scientists to anticipate and prepare for an emergency.

Beginning in 2006, WDIN began disseminating news stories about wildlife disease regularly through the Wildlife Disease News Digest. By incorporating Tweets, news stories, official reports,  and citizen observations  into the web-based data system, WDIN is committed to creating a free, public, easily accessible wildlife health dataset for researchers and organizations to use, Hines said.  In the future, the WDIN group aims to create an open access ‘Wildlife Health Atlas’ to explore and review reports from all channels.

To learn more about WDIN, visit To connect with the network on social media, visit or


August 20, 2013  | By Ann Grauvogl

Biodiversity and Health Workshop

“During “Rio+20” (the 20th anniversary of the Rio Declaration on Environment and Development) the Director General of the World Health Organization (WHO) announce the release of “Our Planet, Our Health, Our Future,” documenting linkages between Continue reading