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Emerging Opportunities in Global Health

Emerging Opportunities in Global Health. Andres G. (Willy) Lescano, PhD, MHS, MHS Associate Professor , Universidad Peruana Cayetano Heredia Adjunct Professor at Tulane, Wake Forest , Johns Hopkins and Texas Medical Branch University

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Emerging Opportunities in Global Health

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  1. EmergingOpportunities in Global Health Andres G. (Willy) Lescano, PhD, MHS, MHSAssociateProfessor, Universidad Peruana Cayetano Heredia AdjunctProfessor at Tulane, Wake Forest, Johns Hopkins and Texas Medical BranchUniversity Head, Emerge , EmergingDiseases and ClimateChangeResearchUnit Sponsoredby training grantNIH/FIC D43 TW007393

  2. El burro por delante(a bit aboutmyself) • Quantitative ID fieldepidemiologist • Workedfornearly 25 years, mostly in Peru: PRISMA NGO, Cayetano University and NAMRU-6 • Research in parasites & emerginginfections. Epicapacitybuilding(~115 publications, H-index: 18) • Interests: emergingdiseases & climatechange, parasiticinfections, surveillance & outbreak response

  3. Peru’spotential and role • High ecologic/pathogendiversity. LargeAmazonicregion • Intense travel, migration and tourism • No emergingdiseasesacademicreference center, onlypublic (INS) and internationalone (NAMRU-6) • Multiple, recently emerged/diagnosedpathogens • Little exploredvectors and reservoirs

  4. Experience in outbreak investigations

  5. Outbreak Investigation Training • Hands-on, five-day classroom-based course • >1600 students from 15 countries trained in >40 courses • Standardized, validated curricula in multiple formats & languages • Collaborates with Ministries of Health, PAHO/WHO, CDC & USAID • Served as model for multiple other training programs

  6. Steps of anoutbreakInvestigation(CDC 3030g, Reingold 1998) • Establishtheexistence of anoutbreak • Verifythe diagnosis • Define and identify cases • Performdescriptiveepidemiology • Determine whois at risk • Develophypotheses • Evaluatehypotheses • Refine hypotheses and conductadditionalstudies • Implementprevention and control measures • Communicatethefindings

  7. Diverse, excitingopportunities“Just come” • Clinicalrotations, withresearchcomponents • Field and laboratoryresearch • Withuniversities, research centers orNGOs • Medical missions, includingsurgicaloreven non-medical • MSF, academic, faith-based • Publichealth: surveillance, outbreakinvestigation & response, programevaluation • Workingwiththe host country government

  8. Stay and commit • Mostproductiveifstaying a long time, avoidvoluntourism • Verydifficult in earlycareerstage • Try to establish a long-term line of research and buildonit • Do as I say, not as I do • Commit to a few places, build local capacities and establishlong-termpartnerships

  9. Don’t be a ‘two-weekwonder’ • Can’tlearnorachievemuch in short stays • Havereasonableexpectations and don’t be animposition • “Ittakessixmonths to findwherethebathrooms are, and twoyears to startbeingproductive” • Try to learn and alwaysaskhow to be of help

  10. Medical missions & “voluntourism”* • Clear benefitfortraveler, lessclear to host • Are theyaddressingneeds (Sanchez JF 2015) • Do theyhaveanimpactonthebeneficiariesor host populations? • Are they a cost-effective? • Do theyerodethe trust on and use of existingservices? http://cmajblogs.com/voluntourism-call-it-a-spade-and-use-it-carefully/

  11. Some personal/closeexperiences • “Just come” • Being there* • “Physician-researcher Robert H. Gilman believes every discovery has its place” * • “Thepeoplehereneed me like a hole in their head” ** * http://magazine.jhsph.edu/2007/Fall/features/being_there/ ** http://magazine.jhsph.edu/2012/spring/features/la-familia-gilman/page-1/

  12. Criticisms& Challenges* • Lack of bidirectionality and reciprocity: inequality of resources in senders/hosts • Risks & costs to students • Cultural shock & sensitivity • Resources of host institutionsstrainedby unilateral flow *Crump & Sugarman, JAMA 2008 Bozinoff et al, Medical Education 2014

  13. What has changed • Greaterdiversity of fields of application • Manyprograms, opportunities and support

  14. TheAmericas, workin progress • More research and internationalstudents • Veryfewprograms and centers • Implementingthe concept isnotautomatic

  15. Outbreaks: be a disease detective • Unconventionalepidemiologicalstudies: • Requirepromptdesign & execution, smallsamplesize, public & politicalpressure • Responsibilityof Ministries of Health, understandtheirexpectations and your role • Threekeyquestions: agent, source& mechanism Euro Surveill 12(11):E071122.4 CDC “Solvetheoutbreak” app www.cdc.gov/mobile/applications/sto/

  16. JoinourPeru Field EpicourseAugust 6-16, 2018

  17. Thank you

  18. Any questions? willy.lescano@upch.pe +51 94761-9799

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