Rollins Magazine - Spring 2022

SPRING 2022

WOMEN CARRYING WATER Strength and number of women faculty set Rollins Center for Global Safe WASH apart IN THIS ISSUE

PANDEMIC FALLOUT 20 SORT at 20 28 2O36 CAMPAIGN 32

2O36: THE FUTURE STARTS NOW

E

mory kicked off the community phase of its most ambitious campaign to date with unique, forwardlooking events on the Emory Quad. Geodesic

domes and a grand stage featured speakers and displays around the university’s strengths, accomplishments,

and plans for the future. See more on page 32.

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FEATURES

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Women carrying water 12

Total eclipse 20

Strength and number of women faculty set Rollins Center for Global Safe WASH apart

Pandemic pushes other health issues into the shadows

COVER STORY

Contributing Photographer

James W. Curran,

Editorial Contributors

MD, MPH

Senior Associate Dean for Advancement and Alumni Engagement, Rollins School of Public Health

Kathryn H. Graves, MEd, 93MPH Editor

Martha Nolan Art Director

Linda Dobson

Worldwide, women and girls bear the brunt of issues surrounding water, sanitation, and hygiene (WASH), yet research in the field has often ignored their concerns. PHOTO BY KAY HINTON

Director of Photography

Stephen Nowland Creative Director

Peta Westmaas

Kay Hinton Karina Antenucci Michelle Hiskey Kelly Jordan Camile Matthews Production Manager

Stuart Turner Executive Director of Content, Communications, and Marketing

Jennifer Checkner Associate Vice President Health Sciences Communications

Nikki Troxclair

Rollins magazine is published by the Rollins School of Public Health, a component of the Woodruff Health Sciences Center of Emory University (whsc.emory.edu). Please send class notes, observations, letters to the editor, and other correspondence to Editor, Rollins, 1762 Clifton Road, Suite 1000, Atlanta, GA 30322. Reach the editor at 404-727-6799 or martha.mckenzie@emory.edu. To contact the Office of Advancement and Alumni Engagement, call Kathryn Graves at 404-727-3352 or email kgraves@emory.edu. Visit the Rollins School of Public Health website at sph.emory.edu. To view past issues of the magazine, visit publichealthmagazine.emory.edu.

Emory University is an equal opportunity/equal access/affirmative action employer fully committed to achieving a diverse workforce and complies with all applicable Federal and Georgia State laws, regulations, and executive orders regarding nondiscrimination and affirmative action in its programs and activities. Emory University does not discriminate on the basis of race, color, religion, ethnic or national origin, gender, genetic information, age, disability, sexual orientation, gender identity, gender expression, and veteran’s status. Inquiries should be directed to the Department of Equity and Inclusion, 201 Dowman Drive, Administration Bldg, Atlanta, GA 30322. Telephone: 404-727-9867 (V) | 404-712-2049 (TDD). © Rollins magazine SPRING 2022

22-RSPH-DEAN-0011 Rollins Magazine - Spring

James W. Curran Dean, Rollins School of Public Health

IN THIS ISSUE

SORT at 20 28

Student team has become valued partner in emergency and outbreak response

2O36 32

Emory’s new campaign aims to transform the future

DEPARTMENTS

CONTRIBUTIONS 36 JOY LAWN 00MPH

DEAN’S MESSAGE 4

CLIFTON NOTES 5

ALUMNI AWARDS 34

ALUMNI CONNECTIONS 35

One of the world’s leading experts on global perinatal data and evidence, Lawn helped catalyze the United Nation’s first sustained development goal on neonatal survival.

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FROM THE DEAN

A secure and shining future

T

he future of the Rollins School of Public Health is very bright as we welcome Dr. M. Daniele (Dani) Fallin as our dean on July 1. We all know Dr. Fallin will build upon the

school’s accomplishments and will help propel us to new heights.

We have significant milestones to celebrate. On February 1, we announced a landmark $100 million gift from the O. Wayne Rollins Foundation—the largest gift in our school’s history. This gift will support faculty and students in perpetuity by strengthening our endowment. These priorities are in line with the Emory 2O36 campaign which was launched publicly last October. Through the generosity of many, many friends, faculty, and alumni, Rollins had secured over $210 million at the mid-point of the eight-year campaign. I want to thank Kathryn H. Graves 93MPH, senior associate dean of advancement and alumni engagement, and her team for their superb efforts in securing transformational support for our school.

Our Center for Global Safe Water, Sanitation, and Hygiene (WASH) is particularly noteworthy as the only academic WASH center headed by a woman. Dr. Christine Moe, Eugene J. Gangarosa Distinguished Professor of Global Safe WASH, leads a distinguished faculty whose research focuses on solving persistent issues of safe water, sanitation, and hygiene. These issues disproportionately affect women and girls, and our center fills a gender gap in the academic world of WASH by focusing on women’s roles in solving these issues.

COVID-19 has touched each of our lives in innumerable ways.

While we navigate the challenges of vaccine acceptance, new variants, and increases in the number of cases and deaths, we must also consider the impacts of the COVID-19 pandemic on other critical public health issues. Our experts describe how COVID-19, through the diversion of health care resources and social factors, has affected diagnosis and treatment of conditions including cancer, heart disease, mental health, HIV/AIDS, diabetes, and domestic violence.

As I make plans to join the faculty of the Department of Epidemiology and the Hubert Department of Global Health on July 1, I want to thank you for the privilege of serving as your dean for the past almost 27 years. I look forward to our continued success.

JAMES W. CURRAN, MD, MPH James W. Curran Dean of Public Health

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CLIFTON NOTES Welcoming a new dean

D

r. M. Daniele Fallin, an internationally regarded researcher and educator, joins Rollins as the new James W. Curran Dean of Public Health on July 1, 2022. Fallin served as chair of the Department

of Mental Health for the Johns Hopkins Bloomberg School of Public Health and was the Sylvia and Harold Halpert Professor and Bloomberg Centennial Professor. She held joint appointments in the Bloomberg School’s Departments of Epidemiology and Biostatistics and the Johns Hopkins School of Medicine’s Departments of Medicine and Psychiatry. Fallin was also director of the Wendy Klag Center for Autism and Developmental Disabilities and led the center since its establishment by the Bloomberg School in 2013.

“The Rollins School of Public Health is globally recognized for its top-ranked programs, innovative research, and outstanding faculty who are transforming the landscape of public health,” says Dr. Gregory L. Fenves, president of Emory University. “Dr. Fallin’s multidisciplinary expertise and many years of experience at the leading school of public health at Johns Hopkins University will elevate Rollins in the years ahead, building on the impressive foundation created by our faculty, researchers, and tremendous students.”

Fallin’s research focuses on applying genetic epidemiology methods to studies of neuropsychiatric disorders including autism, Alzheimer’s disease, schizophrenia, and bipolar disorder and to developing applications and methods for genetic and epigenetic epidemiology, as applied to mental health and development. Known as a tireless advocate for public mental health, Fallin has built a portfolio of mental health research, education, and practice in her current department and has also focused on the well-being, health, and safety of faculty, staff, and students.

“Dr. Fallin has a history of mentoring and supporting faculty, and of supporting impactful, large, interdisciplinary research efforts,” says Dr. Ravi V. Bellamkonda, provost and executive vice president for academic affairs at Emory University. “She also cares deeply about the educational mission of our public health school.”

Fallin succeeds Dr. James W. Curran, who joined Rollins as dean and professor of epidemiology in 1995 following a 25-year career at the CDC where he led the nation’s fight against HIV/AIDS. During Curran’s 27-year tenure as dean, Rollins grew to become one of the most elite schools of public health in the country. It ranks No. 4 by US News & World Report among accredited schools and programs of public health and No. 7 nationally for NIH funding. Curran will retain his position as professor of epidemiology. n

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Operario joins Rollins as new BSHES chair

Dr. Don Operario will join Rollins on July 1 as acting Grace Crum Rollins Distinguished Professor and Chair of the Department of Behavioral, Social, and Health Education Sciences (BSHES). Operario joins Rollins from Brown University School of Public Health where he served as professor of public health in the Department of Behavior and Social Sciences.

Operario’s research addresses two interrelated areas. The first general area concerns the social psychological determinants of HIV, mental health, and related health issues (substance use, structural violence, access to services) in historically marginalized communities, with an emphasis on developing and evaluating theory-based social and behavioral interventions that are relevant for delivery in complex communities. A second research area focuses on the lived experiences associated with social inequality, with an emphasis on understanding the perspectives of intersectional identities and addressing health and psychosocial disparities.

Dr. Cam Escoffery, who served as BSHES interim chair, will return to her position as professor with the department. Dr. Colleen McBride, the department’s chair for nearly eight years, retains her position as professor with the department. McBride’s many accomplishments as chair include: leading efforts to successfully rebrand the department to a name better fitting its mission, hiring 15 new BSHES faculty, increasing MPH enrollment for the department, formalizing faculty mentoring, creating an Office of Evidence-Based Learning, strengthening the BSHES curriculum, leading a strategic planning process for BSHES, and more. n

Genetic studies need more diverse participants The field of human genetics must improve the diversity of research participants to avoid worsening existing health inequities among different racial and ethnic groups, particularly where heart disease is concerned, according to a December 2021 article in Nature.

Blood cholesterol levels (also called lipid levels) are highly genetic, highly treatable, and serve as a primary risk factor for heart disease, the leading cause of death worldwide. However, most previous genome-wide association studies—a study design used to detect associations between genetic variants and common diseases or traits in a population—have been conducted in European ancestry populations.

Therefore, they may have missed genetic variants contributing to blood 6

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cholesterol level variation in other ancestry groups.

The article, a large collaboration with hundreds of coauthors from more than 200 studies in 44 countries, found that most genetic variations that influence lipid levels are observed across all populations, but at least some variants are uniquely observed in one population, particularly among individuals with African ancestry or Hispanics.

“A sensible and equitable approach is to ensure diverse ancestries are represented in genetic studies whenever possible. Diversity helps to determine the degree to which findings can be generalized to other health traits and diseases,” says Dr. Yan Sun, associate professor of epidemiology, who is co–senior author on the paper.— Karina Antenucci

CLIFTON NOTES Helping trauma victims in Pakistan Dr. Muhammad Zia ul Haq 21MPH helped develop an app that provides life-saving trauma advice to people in Pakistan. During his medical school training in Pakistan, Zia (which is the name he commonly uses) saw firsthand the trauma and injuries resulting from the country’s traffic issues. While earning an MPH, one of his former medical school classmates died in a traffic accident.

Zia began working with the Emory Collaborative Advanced Trauma Care project where he directly assisted with developing and deploying an innovative new Prehospital Transport to Hospital (PATH) smartphone app.

The prototype Android app became available for download in December 2021, with a version planned for the Apple store in the next phase of the project. The app, specifically designed for people in Pakistan, helps patients locate the nearest emergency facilities and self-educate with emergency trauma care to save more lives and improve health outcomes.

Users of the app involved in an accident— either as a bystander or victim—fill out an online live questionnaire that brings up relevant information regarding the best next trauma care steps explained with pictures and plain language, while also collecting patient data.

Then, the app provides navigational information (provided via Google Maps) to the nearest hospital where beds and facilities are available. A website version is also available for people who don’t want to download the app, or for collaborators interested in learning more about the project.

“This will establish a mobile-applicationbased prehospital communication, transport, and guidance system between bystanders, prehospital care providers (ambulance service), and emergency departments in order to improve field-based trauma care, transport to the appropriate referral network hospital, and handoff and preparation for in-hospital providers,” says Zia. n

Air pollution may increase risk of Alzheimer’s Long-term exposure to air pollution may increase the risks for developing dementia and Alzheimer’s disease, according to a study led by Rollins researchers in collaboration with colleagues at Georgia Tech and Harvard T.H. Chan School of Public Health. Of the pollutants analyzed, fine particulate matter was associated with the greatest risk of neurodegeneration incidence. A difference of three micrograms per cubic meter of air of fine particulate matter would lead to a seven percent increase in the incidence of Alzheimer’s disease, according to the study.

“We observed a very strong signal between fine particulate matter exposure and increased risks of dementia and Alzheimer’s disease,” says Dr. Liuhua Shi, assistant professor of environmental health and co-lead author on the paper. “To better inform policy for targeted source-specific regulations, it is

important to further investigate the relative contributions of various fine particulate matter components to these conditions, which we are planning to do next.”

Whether the fine particulate matter species that cause the neurodegeneration are from vehicle tail pipes or from tire and brake wear is important to determine. It not only affects mitigation strategies, but the conversion to electric vehicles in the future may or may not help to mitigate this hazard.

The Environmental Protection Agency’s current air quality standards for fine particle pollution is 12 micrograms per cubic meter of air. However, according to these findings, that may not be nearly low enough. The study found strong effects on the risk of developing Alzheimer’s disease down to four micrograms per cubic meter of air. n SPRING 2022

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Link between heart disease and PTSD PTSD (post-traumatic stress disorder) has been linked to cardiovascular disease but the reason why was unclear.

Dr. Viola Vaccarino, professor of epidemiology, has been trying to unlock this mystery by studying war veteran twins over a long period of time. “Studying twins allowed us to separate factors that are often associated with both PTSD and heart disease but do not causally link the two disorders, including genetic, environmental, and behavioral factors that run in families and are shared among twins,” says Vaccarino.

Vaccarino and her team looked at examinations of 275 twin participants that were 12 years apart.

Both exams included a clinical assessment of PTSD and heart imaging scans of myocardial perfusion with Positron emission tomography, which show how well blood flows through the heart muscle.

This technique allowed the researchers to assess myocardial flow reserve, which is a measure of the health of the small coronary vessels that bring blood within the heart muscle, known as the coronary microcirculation. Unlike obstructive coronary artery disease that affects large coronary vessels, dysfunction of the coronary microcirculation is caused by excessive tightening or malfunction of these small blood vessels rather than blockage by atherosclerotic plaque.

Among the study’s key findings are: n PTSD is associated with dysfunction of the coronary microcirculation rather than accumulation of coronary atherosclerotic plaques.

This was also noted over time, showing deterioration of the heart’s microcirculation and reduced blood flow between the two visits. n The connection between PTSD and ischemic heart disease was particularly noted amongst twins with longstanding PTSD, which suggests that the long duration of the condition plays a role. n The connection was noted even when comparing twin brothers who differed in PTSD diagnoses. This ruled out influences from environmental, behavioral, or genetic factors that are shared by brothers and that may be precursors of both PTSD and heart disease.

These data fill a significant gap in evidence concerning the longterm consequences of PTSD on the heart. Understanding the connection between the two should help in long-term efforts for risk prediction, prevention, and treatment to reduce the burden of ischemic heart disease among individuals with PTSD.—Karina Antenucci

New Emory TB research center Supported by a grant from the National Institute of Allergy and Infectious diseases, Emory and three other institutions will form the Emory/Georgia Tuberculosis (TB) Research Advancement Center (Emory/ Georgia-TRAC). Led by Dr. Neel Gandhi, professor of epidemiology, and Dr. Jyothi Rengarajan, professor of medicine at Emory Vaccine Center, Emory/Georgia-TRAC will expand collaborative multidisciplinary TB research in the US and internationally, and train the next generation of TB researchers.

Emory/Georgia-TRAC will include colleagues from the University of Georgia, Georgia State University, Morehouse School of Medicine, and Georgia Tech. It will also work closely with public health professionals in the Fulton and DeKalb County health departments and the Centers for Disease Control and Prevention.

“The statewide alliance helps us form a common umbrella under which TB investigators in Georgia can find new opportunities for collaborations and synergy,” says Rengarajan. “We are also using our 8

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strengths in areas like vaccines, immunology, epidemiology, systems biology, and microbiology.” n

Del Rio, Foege named to American Academy of Arts and Sciences Two Rollins faculty members have been elected to the American Academy of Arts and Sciences, one of the nation’s oldest and most prestigious honorary societies and a leading center for independent policy research.

Dr. Carlos del Rio, professor of global health and epidemiology, executive associate dean, Emory School of Medicine and Grady Health System; Leon L. Haley Jr. MD Distinguished Professor of Medicine, is one of the nation’s foremost experts on infectious disease. Del Rio serves as codirector of the Emory Center for AIDS Research and Co-PI of the Emory-CDC HIV/AIDS Clinical Trials Unit and the Emory Vaccine and Treatment Evaluation Unit. In 2021, del Rio received the city of Atlanta’s highest honor, the Phoenix Award, for his pivotal role in providing civic leaders and the community as a whole with expert medical and public health guidance and support during the COVID-19 pandemic.

Dr. William Herbert Foege, Emeritus Presidential Distinguished Professor of International Health, was the winner of the Presidential Medal of Freedom in 2012 and the Emory University President’s Medal in 2016. He has also served as executive director and fellow for health policy at The Carter Center and as a senior medical adviser for the Bill & Melinda Gates Foundation. Foege served as chief of the Smallpox Eradication Program of the Centers for Disease Control and Prevention and was appointed director of the CDC in 1977. In 1984, he and several colleagues formed the Task Force for Child Survival, a working group for the World Health Organization, UNICEF, the World Bank, the United Nations Development Program, and the Rockefeller Foundation. Its success in accelerating childhood immunization led to an expansion in 1991 to include other issues that impact children. The organization, headquartered in nearby Decatur, was renamed the Task Force for Global Health and is affiliated with Emory. n

Passing of a school founder Dr. William (Bill) Marine 53C 57M 62MR died on May 3, 2022, in Boulder, Colorado. Marine, along with his colleague Dr. Thomas F. Sellers, conceived of and created the master of community health program within the Emory School of Medicine that would grow to become the Rollins School of Public Health.

Marine joined the school of medicine faculty in 1963, after serving as an Epidemic Intelligence Service (EIS) officer at the Centers for Disease Control and Prevention (CDC). He worked with the dean of the medical school as well as colleagues at the CDC, the Georgia Department of Human Resources, Georgia State University, and throughout Emory to formulate and flesh out his plan to launch a new public health program. Marine served as the program’s first

director from 1974 to 1975, and he and taught the first measurement sciences course.

Marine left Emory to join the University of Colorado to create and teach the introduction to clinical medicine course. He helped the school of medicine create a master’s program focused on community health, then tackled the challenge of creating the preventive medicine residency in collaboration with the state’s public health leadership. His efforts were complimented by colleague and wife Susan Marine, also on faculty at the school of medicine for several years.

“Emory likely would not have a school of public health if not for the efforts of Bill Marine,” says Dean James Curran. “We will always be indebted to him for his foresight and determination.” n SPRING 2022

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CU

UB

AN FAN CL RR

CELEBRATING

CURRAN O

1.

n the eve of his departure from the post he has held for almost 27 years, Dean James

Curran is honored by the school’s faculty, staff, students, alumni, and friends. Everyone, it seems, is a member of the Curran Fan Club.

2.

3.

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4.

6.

5.

8.

9.

7.

10.

11.

Above: 1. Dean James Curran listens to toasts at a Dean’s Council dinner honoring him; 2. Gary W. Rollins; 3. A Rollins graduate from every year in which Curran was dean lined the stage at the last commencement over which he will preside; 4. Melissa H. Lowe applauds Curran; 5. Amy Rollins Kreisler gives Curran a hug;

6. Ann Estes Klamon; 7. Pam R. Rollins; 8: Curran is toasted at an alumni event; 9. Eric Pevzner thanks Curran at the alumni event; 10.

Students, faculty, and staff flocked to a picnic honoring their dean; 11. Curran enjoys the picnic with his wife Juanita and daughter Katie Curran. See more photos at emory.edu/!eeid2022 n

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WOMEN CARRYING WATER Strength and number of women faculty set Rollins Center for Global Safe WASH apart B y M i c h e l l e H i s ke y P h o t o g r a p h y b y Ka y H i n t o n

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W

here are the women? Dr. Sheela Sinharoy 17G

asked herself that in October 2016 at her first water, sanitation, and hygiene (WASH) conference in Chapel Hill, N.C. She felt out of place, which never happened within her field of nutrition and health sciences.

At the coffee table between sessions, Sinharoy looked for someone who looked like her. “I personally feel safer going up to a woman, and I realized that I had to actively look for a woman to talk to,” recalls the assistant professor of global health. “I never would have had to do that at a nutrition conference.” And she needed to look no further than the conference presentations to see that women and girls were left out of most WASH research.

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Her experience reflected the historical disconnect in WASH research: the people doing it don’t look like the biggest stakeholders. WASH research began in engineering, when that field was dominated by men. Their studies and interventions often missed or neglected women’s concerns— and those are significant, given that women and girls worldwide are doing the washing, cleaning, caring for children, and preparing food. Each day worldwide UNICEF estimates women and girls spend 200 million hours collecting water. In some countries, women and girls experience restrictions on where and when they can defecate.

Rollins is addressing those concerns. Sinharoy is among seven female core faculty researchers at the only academic WASH center headed by a woman. They are teaching and leading research that centers women and gender in solving persistent issues of safe water, sanitation, and hygiene. Many are balancing their careers with raising their own children, deepening their connection to families around the world, including those who struggle to secure safe water and sanitation.

“Of course we have outstanding male researchers in our center who have made significant contributions to the field,” says Dr. Christine Moe, director of the Center for Global Safe Water, Sanitation, and Hygiene at Emory (CGSW). “What is unique about RSPH is that we have a large cadre of women scientists working on a range of WASH research, and this puts us in an especially strong position to address gender-related aspects of WASH. “Women approach things differently,” continues Moe. “It’s critical to bring women’s perspective into WASH challenges, whether it’s access or whether it’s the outcomes that impact women. It just makes a huge difference.”

Bethany Caruso and Sheela Sinharoy (l-r) are leaders in bringing the issues of women and girls to the study of WASH conditions and outcomes.

RISING ABOVE THE GLASS CEILING OF WASH Moe recalls getting her master’s and doctorate in the 1980s at the University of North Carolina, a leading WASH research institution, where all but one of her professors were men. “They were mainly engineers, chemists, microbiologists,” she says. “It does make a difference when the professors are men. As an example, never, ever in my graduate school did anybody mention menstrual hygiene management.”

Moe honed in on how infectious diseases that are foodborne and waterborne, such as noroviruses, are transmitted through the environment. In her global field work, she paid attention to how women and girls were affected by water, sanitation, and hygiene in field research in low-resource countries. “When I study public and household sanitation systems overseas, I always try to ask women if they are satisfied with their sanitation facility. It is critical to hear their 14

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perspective,” explains Moe. “I have shown women in Senegal photos of the septic tank at my house to help build connection and make the point that this is a sanitation solution that I use also.”

Moe’s stature in WASH rose in part because she found a champion for her work at Rollins in the 1990s—Dr. Eugene Gangarosa. A pioneer in the field, Gangarosa established the school’s WASH center, as well as endowing several chairs. He and his wife Rose were honored for his vast contributions to the field and the school when his department was named the Gangarosa Department of Environmental Health.

Gangarosa always appreciated women’s influence in households.

The Hubert Department of Global Health Emeritus Professor “would talk about how household water treatment allowed the homemaker to provide cleaner, safer water for her family,” recalls Moe, the Eugene J. Gangarosa Chair of Safe Water and Sanitation.

“The term ‘homemaker’ is from Dr. G’s generation, and it was his

later the Task Force for Global Health that worked on different aspects of WASH and health, and it was Dr. G who brought them together,” says Moe, who joined the Rollins faculty in 2000.

With this foundation, Rollins became the only school of public health to offer a WASH certificate starting in 2012. And as water, sanitation, and hygiene issues received growing attention—specifically promoted by UN Sustainable Development Goal (SDG) 6 (“securing availability and sustainable management of water and sanitation for all”)—Rollins researchers were making gender a more prominent topic. In 2019, Rollins women researchers and alumnae headlined a University of North Carolina Water and Health Conference symposium dedicated to closing the gender gap. They had spent years pushing the spotlight to how women and girls are not only instrumental in WASH but can also be empowered by it.

Moe; Sinharoy; Dr. Bethany A. Caruso 09MPH 15G, assistant professor of global health; Dr. Joanne McGriff, assistant dean for diversity, equity, and inclusion; Sarah Durry 18G; and Allison Salinger 18MPH were recently awarded an inaugural Women of Emory Impact Circle Grant. They plan to use the award to develop a robust online leadership training curriculum, a virtual global network of professional WASH women, and mentoring opportunities that can serve the Emory community of WASH faculty, staff, and students and provide connections to women WASH professionals all over the world.

“We realize that it is not enough to have ‘a seat at the table.’ Women also need to have a voice and be decision makers in the WASH sector, and that requires training, networking, and mentorship,” says Moe.

WOMEN’S EMPOWERMENT MATTERS MORE WHEN IT’S MEASURED recognition of the pivotal role that women play in trying to provide clean water for their families—and how they also were the ones that were responsible for taking care of their children who had cholera, the area he worked in.”

As a child in Sicily, Gangarosa had seen that firsthand: four of his mother’s first five children died of childhood infectious illnesses related to unsafe water that she had to fetch and to unsanitary conditions from animals living too close to the family. Starting with a landmark 1959 study of the pathophysiology of cholera, his career focused on intestinal infections, and his early work helped lead to the development of oral rehydration therapy, which is credited with saving millions of lives.

Today the Center for Global Safe WASH at Emory is a consortium of researchers, implementers, educators, and representatives from other sectors who work individually and together. “In Atlanta, there were all of these groups like the CDC, CARE, The Carter Center, Georgia Tech, and

But how is women’s empowerment linked to WASH research? Led by Caruso, Rollins women WASH faculty are assessing what previous research has missed. A team of seven women researchers, including Sinharoy, recently used a Bill & Melinda Gates Foundation grant to conduct a systematic review of WASH research. They determined that only minimal research in WASH focuses on improving the life outcomes of women and girls.

“Gender-transformative approaches to challenge and reduce systemic constraints on women’s and girls’ resources and agency are not only warranted but long overdue,” wrote Caruso, a global leader in this field.

No validated survey tools existed to measure women’s empowerment in WASH, which led Caruso and Sinharoy to form and co-lead the MUSE (Measuring Urban Sanitation and Empowerment) project to develop these tools for urban sanitation programs. This type of research contributed to Emory’s recent ranking as most influential institution in women’s empowerment research by Women’s Studies International Forum.

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Around one-third of the 47 core faculty members in the Hubert Department of Global Health contribute to this type of research, which focuses on how women can advance their capabilities individually and collectively.

These researchers have produced evidence to suggest that empowering women in households and communities has a cascade of benefits for alleviating poverty, improving food security, increasing the health and nutrition of children, and improving women’s own health and well-being.

This shift didn’t just happen. As Caruso got a PhD at Emory, she kept trying to make sex and gender issues noticed in WASH. When she went to the 2011 WASH conference, “I was one of only a few actually presenting data disaggregated by sex,” she recalled. In 2012, she started presenting papers and organizing symposia on sex and gender–focused WASH work, including but not just about menstruation. Likeminded Emory students and alumni joined her.

“Bethany’s really one of the people who is responsible for this explosion of interest among other researchers as well as among WASH practitioners,” says Moe. “The bigger problem of the glass ceiling is still very much there in the WASH sector. It’s one thing to say, ‘Oh, we need more women in a village water committee’ or ‘we need more women involved in WASH decision-making at a local level.’ But, in order to achieve that, you also need more women at the leadership level in the WASH sector—in government, academia, nongovernmental organizations, and the private sector.”

Caruso joined the Rollins faculty in 2019 and is an assistant professor of global health with a joint appointment in environmental health and behavioral, social, and health education sciences. The WHO / UNICEF Joint Monitoring Programme for Water, Sanitation, and Hygiene, which monitors global progress toward SDG 6, tapped her to help them understand how to monitor gender-specific progress related to WASH, to lead an effort to identify indicators for global monitoring of gender in WASH, and to do so with broad stakeholder buy-in. “That’s one of the ways that gender is actually getting embedded into global work,” says Caruso.

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World Vision also came to her for help designing and evaluating WASH programs in Central America and Africa that will be specifically focused on improving women’s empowerment, safety, and leadership, among other outcomes focused specifically on women and girls.

“All these outcomes are specifically related to women, and that’s not something that we’ve seen,” says Caruso. She is seeing the results of years of “banging the drum on the fact that in all these [previous] WASH interventions, nobody’s actually doing anything that specifically aims to improve the life outcomes of women.”

GENDER-RESPONSIVE WASH IN HEALTH CARE FACILITIES McGriff has been an advocate for factoring women into the WASH equation in health care facilities since she joined CGSW as associate director in 2012. McGriff worked with Moe, who got funding from the GE Foundation, to lay the foundation for understanding the dearth of adequate WASH facilities in hospitals and other health care facilities in low-resource countries.

Though McGriff has left her associate director post to become assistant dean for diversity, equity, and inclusion, she remains a core researcher in CGSW, and she created a WASH in health care facilities community of practice, which she co-leads with Lindsay Denny, senior public health program associate.

“We started in 2018 with a webinar series to connect practitioners and people in the field with evidence, ideas, and best practices,” says McGriff. “We cover a wide variety of topics, but gender responsiveness is one of our cross-cutting themes. At some point in every presentation, we look at the situation through a gendered lens.”

With good reason. Poor WASH conditions in health care facilities disproportionately affect women and girls—both patients and staff. Women are routinely encouraged to give birth in health care facilities rather than at home, but they are often confronted with horrific conditions. “We find women bringing four or five jugs of their own water with them to delivery because otherwise they would have no water to bathe themselves after the delivery or to bathe the baby,” says McGriff. “Some

Christine Moe is the only woman to lead an academic WASH center. She is pictured above with Eugene Gangarosa and his wife Rose. Gangarosa, a pioneer in the field of WASH, mentored Moe and recommended that she apply for a faculty position at RSPH in 2000. In her own research, Moe, right, has been testing wastewater from vulnerable areas of Atlanta for SARS-CoV-2, helping the CDC develop a national wastewater surveillance system to better track COVID-19 in underserved communities.

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facilities don’t have toilets with adequate privacy, and some don’t have any toilets at all.

As a result, some women elect to have their babies at home, without the supervision of a health care worker.”

Female staff at the health care facilities must navigate the same lack of resources, but all day every day. “If there is no private or functioning toilet, no way to manage menstruation, women can’t perform their best on the job,” says McGriff. “We find some women are holding their urine during long shifts to the point they develop urinary tract infections. Some women don’t come to work when they are menstruating.”

These examples point to the need to include women in WASH in health care facilities design, planning, and implementation.

And that’s just what McGriff and her team have been working to do.

THE RIPPLE EFFECTS OF INADEQUATE WASH CONDITIONS How do women experience their water and sanitation environments? What are their health risks because of linked burdens such

as preparing food while tending a sick child?

Dr. Elizabeth Rogawski McQuade 10C brought these questions with her last year when she joined Rollins as an assistant professor of epidemiology, with joint appointments in environmental health and global health.

She is collaborating on a new study in Tanzania and Bangladesh to identify the transmission pathways for two common bacteria—Shigella and Campylobacter—that cause infectious diarrhea. “Let’s say we see that these pathogens are rarely in the drinking water,” she says. “But maybe contaminated food is coming into the house from the market, or the mother’s not able to wash her hands and is inadvertently contaminating the food during preparation. Maybe we identify contaminated food as being the dominant pathway. We’ll try to understand better how these specific pathogens are infecting children, with the hope of evaluating more targeted interventions in the next study.”

In her doctoral dissertation, McQuade examined how antibiotics affect diarrheal risk and growth of children in low-resource places.

She spent a year in India studying unclean

Joanne McGriff, left, was an associate director of CGSW until 2020 and remains a core researcher. Maya Nadimpalli, right, is the center’s newest faculty member, joining in May. 18

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environments that lead to diarrhea, one of the top five causes of death for children globally, and environmental enteric dysfunction, a seemingly asymptomatic condition of the gut that leads to poor child growth. Mothers “are the conduits for access to water and sanitation,” McQuade says. “They are extremely central to everything I do.”

Raising an infant son, McQuade feels bonded with her colleagues. “The fact that there are many other women in WASH at Rollins makes me feel like I belong and my perspective is valued,” she says. “We have similar triumphs and struggles.

Having both mentorship and sponsorship from women has been really critical for my career success and just general happiness.”

WOMEN’S FARM DUTIES CAN MAKE THEM TARGETS FOR ANTIBIOTIC -RESISTANT BACTERIA An environmental microbiologist, Dr. Maya Nadimpalli has studied antibiotic use in animals raised for food, and how bacteria that are resistant to specific antibiotics can spread from animals to humans. When she started examining how humans can prevent bacteria from developing resistance, she found herself looking squarely at water, sanitation, and hygiene, and the role of women.

“These bacteria are really everywhere—in water, soil, air, animals, and people—and the scale of it suggests that that there is a major role for modern WASH infrastructure to play, both by preventing exposure to drug-resistant pathogens, and—if successful in reducing the infectious disease burden more generally—by reducing some countries’ long over-reliance on antibiotics for both prevention and treatment,” she says. In some low-resource countries, she notes, “rural women are more likely to be exposed to these multi-drug-resistant bacteria because they’re the ones who are handling livestock that are often colonized, like chickens and pigs.”

She is also investigating how breastfeeding confers protection for young children against resistant bacteria. When she joined the faculty as an assistant professor in May, Nadimpalli came under a big tent for collaboration across disciplines. “The natural convergence is really exciting and a major reason why I wanted to come to Rollins,” she says. “Together, we can have a unique impact on WASH and health.”

SUCCESS IN WASH DEPENDS ON INCLUDING WOMEN Sinharoy came to Rollins as a postdoctoral fellow in 2017 and joined the faculty three years later with a joint appointment in global health and environmental health. Because the voices of women and girls must be central in WASH research, Sinharoy is co-leading a study focused on gender and social inclusion to help ensure that everyone gets access to safe water and sanitation.

“WASH infrastructure is often designed without consulting women and others whose voices are not traditionally heard,” says Sinharoy. “As a result, it may not meet their needs and may not be used by them.

One main output of our study will be a toolkit for participatory design of WASH infrastructure, with a strong emphasis on participation of women.”

Sinharoy transitioned to WASH from Emory’s nutrition and health sciences doctoral program, and like Moe, a high-ranking male faculty member opened the door. As a student blogger for the American Society for Nutrition, she noticed a New York Times piece about Dr. Thomas Clasen, Rose Salamone Gangarosa Chair of Sanitation and Safe Water, concerning sanitation and diarrhea. Sinharoy knew that diarrhea was a major cause of malnutrition in India and other countries, so she interviewed Clasen. When he mentioned needing a nutrition person for one of his studies, Sinharoy raised her hand. He cochaired her dissertation committee, and they are still collaborating.

At Rollins, Sinharoy does not see the dearth of women that she encountered at that conference long ago. “The women who are working on WASH at Emory are absolutely incredible: brilliant, capable, collaborative, and genuinely kind,” she says. “By working together, we can help each other, help ourselves, and help women around the world.”

DIVERSE VOICES MEAN BETTER SOLUTIONS FOR MORE PEOPLE Women researchers are bringing more diverse voices into solving problems with water, sanitation, and hygiene. One size doesn’t fit all but having more varied voices can produce solutions that could fit more people.

The work of Elizabeth Rogawski McQuade and Marlene Wolfe (l-r) is informed by recognizing the central role women play in accessing water and sanitation for their families.

Case in point: the hand-washing research of Dr. Marlene Wolfe, assistant professor of environmental health since 2021. Her current work on hand washing solutions for refugees could lead to solutions for unhoused and transient people in the US and around the world. While this project does not focus on gender, gender informs it; women are often responsible for managing hand washing and hygiene in the home.

Women researchers are promoting a more layered view of how men, women, and children interact with water and sanitation.

Having a more gender-inclusive team helps shift away from “one direction of knowledge creation,” says Wolfe, an environmental microbiologist, environmental engineer, and mother of two. “The best thing that we can do is to increase participation in this field from people who represent all the different perspectives, needs, constraints, and innovation around the

world, because they inform each other.”

Clean water and sanitation are universal basic needs that bridge people’s differences, and for Wolfe and her peers, this solutionsoriented work carries great meaning through its immense potential to make life better for people in need.

“When I go into the field and speak to people about WASH in their homes, often they really want to relate about the experience of being a woman. They want to know if I am a wife and a mother, and they want to share that experience,” she says. “Those are powerful connections made in the community, and I think it’s important that we have research teams that have representatives with different identities. Aside from being the right thing to do, an inclusive environment will improve our work. We will have better solutions and better options for people and elevate all people in a way that gives respect and dignity.” n SPRING 2022 19

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n January 2020, after more than a year of locally tailoring and testing an intervention to improve detection and care of diabetes and hypertension in rural communities, Dr. Shivani Patel and her team with the Emory Global Diabetes Research Center launched the initiative out of the Nawanshahr district hospital in India.

“This intervention, which involves electronic capture of patient data to guide clinical decisions, was quite successful in randomized controlled trials, so we were very excited to roll it out in a real-world setting,” says Patel, Rollins Assistant Professor of Global Health with a joint appointment in epidemiology.

“We partnered with the state and local government to design a program that incorporated these tools at every level of the health care system. We believe it has strong potential to help curb the burden of diabetes and hypertension.”

Two months later, the hospital that was the center of Patel’s study was the site of the first COVID-19 death in the area. The facility was quickly closed to all but COVID patients, and the diabetes and hypertension program was shuttered indefinitely.

Similar scenarios were playing out across the globe as all available resources and personnel were diverted to fight the pandemic. In overrun hospitals and clinics, providers at all levels, from physicians to support staff, were pulled from their regular duties to care for COVID-19 patients. Researchers halted their own studies to pivot and focus on the deadly new virus. Politicians focused their policies and budgets on dealing with the pandemic. COVID-19 became writ large on the public health landscape—so large that all other concerns, like diabetes, were pushed into the shadows.

“At first, there was no option but to focus all available resources on the COVID pandemic,” says Patel. “But we could see that these disruptions to health care systems had implications far beyond COVID by delaying the diagnosis and treatment of other conditions.

As we emerge from the acute crisis, we must ask how will the pandemic affect the burden of diabetes, of cancer, of mental health?”

How indeed. Let’s take a look.

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COVID-19 has worsened diabetes

in almost every way. People with diabetes who contract the virus are at higher risk than their non-diabetic counterparts to develop severe symptoms and complications, to require ventilation, and to die. The many stressors the pandemic has inflicted on everyone have caused many people with diabetes and pre-diabetes to lose control of their condition.

And some evidence suggests a COVID-19 infection could lead to the emergence of diabetes in a previously non-diabetic person, and this has major implications for the future global burden of diabetes.

“No matter how you look at it, the COVID-19 pandemic has increased the overall burden of diabetes,” says Dr. K.M. Venkat Narayan, the Ruth and O.C. Hubert Professor of Global Health. “Since the pandemic started, there have been 100,000 more diabetes-related deaths each year compared to K.M. VENKAT NARAYAN pre-pandemic years, and that is just in the US. The situation in low-resource countries is likely far worse.”

Diabetes can be a difficult disease to control in the best of circumstances. Factor in lost income and/or insurance, fear of contracting the virus at a doctor’s office, shelter-in-place and in-home schooling, and disease management becomes much harder.

In his clinical practice, Dr. Mohammed K. Ali saw all of these issues contributing to a big problem—weight gain. “My patients told me they couldn’t go to the office, out to see friends, or to the gym to work out, so they sat at home and snacked,” says Ali, professor of global health and epidemiology. “About 80 percent of my patients complained of weight gain, and that tipped the scales for some. The proportion of Emory’s MOHAMMED K. ALI patients having very poor glucose control ballooned from about 15 percent to 18 percent in 2019 to as much as 25 percent in 2020. We’ve clawed our way back to somewhere near 15 percent, but it has taken a concerted effort.”

Like almost all physicians, Ali pivoted to exclusively providing virtual telehealth visits early in the pandemic and has since moved to a combination of in-person and virtual appointments. The rise of virtual office visits brought some good results, including convenience for physicians and

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patients and fewer missed visits. However, telehealth has its limitations.

“Studies have shown that people with diabetes largely were able to see their doctors in the first year of the pandemic, often virtually, but what they weren’t able to do was get their labs done, get their feet and eyes checked, and get screenings for early signs of diabetes-related kidney disease,” says Ali. “People with diabetes need to be screened for eye damage that could lead to retinopathy and blindness, foot sores that could become gangrenous, and chronic kidney disease, but many patients were not able to get those screenings. That has the potential to be a big issue going forward.”

People with diabetes who get COVID-19 face a heightened risk of serious symptoms and complications, including death. Recent studies suggest people with diabetes may also be more likely to develop long-haul COVID. Ali recounts one of his patients, a healthy, middle-aged woman with prediabetes who got COVID-19 in December 2020. She recovered, but a few months later developed severe fatigue, asthma-like symptoms, and “brain fog.”“This is a woman who used to do yoga four times a week and walk three times a week,” says Ali. “Now she can barely cross a room without getting winded and needing to sit down. She’s gained weight and tipped from having pre-diabetes to diabetes. She’s really struggling.”

Though there is some controversy surrounding these findings, data from several parts of the world suggest COVID-19 might trigger the onset of diabetes or pre-diabetes in previously healthy people. “It seems COVID itself may be a risk factor for developing diabetes,” says Narayan. “Whether COVID is causing a problem that already existed to surface or creating the problem is unclear. Could the virus be damaging the pancreas? We don’t know yet, but clearly the connection between COVID and diabetes is very, very strong.”

Given the difficulties COVID has dealt people with diabetes, experts expect to see a jump in cases after the pandemic. Today, 14.5 percent of (or 37 million) Americans, or one in seven, have diabetes. That’s up from 12 percent (or 30 million) just five years ago.

“Given the weight gain, depression, and decline in self-care, I think we are going to see a burgeoning in diabetes in the coming years,” says Ali. “I think we are headed toward one in six.” n

People with cancer tend to have an impaired immune system, either due to the cancer itself or its R CANCE treatment. That, in turn, may put them at higher risk for contracting COVID-19 and for suffering serious complications and death.

Contracting COVID-19, however, is but one of the worries cancer patients have faced during the pandemic. An American Cancer Society Cancer Action Network (ACS CAN) survey of cancer patients and survivors found that of those in active treatment, 79 percent reported delays to their health care, including 17 percent of patients who reported delays to their

cancer therapy like chemotherapy, radiation, or hormone therapy. One in five of the respondents say they are worried their cancer could be growing or returning due to delays and interruptions caused by the COVID-19 outbreak.

“Dealing with cancer is scary enough, but dealing with it during a pandemic that turns everything, ILANA GRAETZ including health care, upside down is another thing entirely,” says Dr. Ilana Graetz, associate professor of health policy and management.

Graetz and a colleague in the School of Medicine got an Emory Synergy award to look at how the pandemic impacted oral chemotherapy adherence for women with metastatic breast cancer. Results are still preliminary but find that 26 percent of patients reported missing doses of their medication, largely because of side effects. “More than 20 percent of the respondents reported their doctor’s office closed or cancelled appointments because of COVID,” says Graetz. “If you’re not going in to see your doctor regularly, you might not be getting good symptom management, which could cause you to miss a dose.”

Another study that came about by chance confirmed missed doctor’s appointments to be a challenging problem. Graetz already had a study underway, looking at KEVIN WARD ways to improve therapy adherence among women with breast cancer being treated through a large cancer center in Memphis. When COVID-19 hit, she added questions about the impact of the pandemic to her surveys. She found a steep decline in office visits during the first year of the pandemic, to four visits in the previous six months from 10 visits pre-pandemic. More recent surveys show visits have inched up to six visits in the previous six months, but they have still not recovered to pre-pandemic levels.

Screenings dropped off more precipitously than treatments or office visits. Indeed, at the beginning of the pandemic, the American Cancer Society (ACS) and other organizations recommended that routine cancer screenings be postponed to prioritize resources for COVID-19. Even after those recommendations were lifted, many continued to avoid screenings for fear of catching the virus. As a result, ACS estimates 22 million cancer screenings were missed or canceled between March and June of 2020, resulting in declines in screening rates for breast, colon, and cervical cancers by as much as 94 percent overall.

Closer to home, Dr. Kevin Ward, director of the Georgia Center for Cancer Statistics and assistant professor of epidemiology, looked at cancer incidence data captured in two Surveillance, Epidemiology, and End Results (SEER) registries, which are able to capture and examine real-time pathology reports. With over 94 percent of all cancers in the

United States pathologically confirmed at the time of diagnosis, these realtime pathology data offer an avenue to explore the impact of events like COVID-19 on cancer-care services. He found an overall 10 percent decline in the number of pathology reports—nearly 30,000 fewer reports—in 2020 from the previous year, although results varied significantly by month. There were almost 43 percent fewer pathology reports in April 2020 than in April 2019.

In the end, delays in diagnosis and interruptions in treatment are expected to increase cancer mortality in the post-pandemic years.

“We won’t know the full implications for cancer outcomes for several years,” says Graetz. “But I suspect they will not be good.” n

As with diabetes and cancer, having HIV puts a person at higher risk for hospitalization and mortality if they contract COVID-19.

And, again as with diabetes and cancer, the pandemic has disrupted prevention, transmission, and treatment services for the disease.

Early on in the pandemic, two things happened simultaneously. Sexual health prevention services, including HIV testing and sexual counseling, shut down, both to divert resources to COVID-19 and to keep people from gathering in clinics. At the same time, shelter-in-place orders and social distancing directives changed patterns of sexual risk. Men who have sex with men (MSM) were having fewer partners and not connecting with new partners.

“We thought these two things might cancel each other out,” says Dr. Travis Sanchez, professor of epidemiology. “Prevention services had declined, but so had the need for them. And in preliminary data, we found that may have been true very early in the pandemic. But by the fall of 2020, that was no longer the case. Prevention services were still by and large closed, but the behaviors of MSM had recovered to pre-pandemic patterns.”

An annual survey of MSM Sanchez conducts confirms the impact of prevention services closures. From fall 2019 to fall 2020, the percentage of respondents who had done HIV testing in the previous year fell 6 percent and testing for other sexually transmitted infections (STIs) dropped 17 percent. The decline for African American MSM was steeper, 15 percent and TRAVIS SANCHEZ 30 percent respectively, further exacerbating HIV disparities. How these decreases will translate into new infections and transmissions remains to be seen.

The same is true for HIV-positive people in treatment. “We are only

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Denise Jamieson and Sarah Blake (left and middle) have looked at how the pandemic has impacted maternal health. Colleen Kelley (right) has gauged its effect on screening, prevention, and treatment of HIV.

just now learning how many people just fell out of care completely during the pandemic, says Dr. Colleen Kelley, associate professor of infectious diseases in the School of Medicine, assistant professor of epidemiology, and a clinician at the Grady Infectious Diseases program. “Many of our patients already faced challenges adhering to their treatment plans—financial challenges, transportation challenges, social challenges. The pandemic exacerbated all of those as well as adding a few more, so I suspect we are going to find that a lot of people just fell out of care.”

On the flip side, the pandemic led to policy changes that have allowed Kelley and her colleagues to use conveniences such as telehealth and mail-order medications. “This flexibility is one of the good things to come out of the pandemic,” she says. “It allows us to do a better job of meeting patients where they are with respect to their treatment.”

Patrick Sullivan agrees. “It’s really challenging to get people to engage with health care when they feel well,” says Sullivan, Charles Howard Candler Professor of Epidemiology. “Introducing patients and providers to the idea that you can manage care via telehealth with mail order medications and lab tests could be a really positive development in the long run.”

PATRICK SULLIVAN Sullivan and his team had been partnering with the Centers for Disease Control and Prevention (CDC) long before the pandemic, evaluating an at-home HIV testing intervention. Results were so encouraging that the CDC was planning to mail out 100,000 testing kits, a plan it moved up and implemented when the pandemic hit. “When we started working on this intervention and others like it, nobody said ‘Well this will come in handy if we have a global pandemic and people can’t go to the doctor,’” says Sullivan. “We were 24

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just trying to lower barriers and improve convenience for receiving HIV testing or getting PrEP, but it turned out to have a different importance in the way we hadn’t imagined. That is the value of research. That is why we invest in not being satisfied with where we are.”

Rollins is collaborating with University of Washington and University of Michigan to use modeling platforms to parse the data to answer the questions of how the pandemic impacted HIV prevention, diagnosis, and treatment. “We’re also hoping to learn more from the pandemic so next time around we can potentially plan better to prevent disruptions in service and care,” says Sanchez. n

Pregnancy alters a woman’s immune system so that her body doesn’t reject the fetus.

It expands her blood volume to the point that it can strain her cardiovascular system. And the growing uterus crowds the diaphragm, which can reduce lung capacity. Introduce a virus that attacks the lungs and cardiovascular system and you have a recipe for disaster.

Pregnant women who catch COVID-19 are more likely to develop severe symptoms, be hospitalized, require admission to an ICU, and die than women who are not pregnant. These women are also at increased risk of preterm birth, stillbirth, and neonatal death.

Given these grim outcomes, it’s no surprise pregnant women were prioritized when vaccines became available. It also may be little surprise that pregnant women were reluctant to go get that shot. The

MATERNAL HEALTH

reason—pregnant women were not included in any of the vaccine clinical trials, so initially there was no data available about the vaccine’s safety for mothers and their infants.

As the pandemic has worn on, CDC surveillance data and several studies have shown that the COVID-19 vaccines are in fact safe for pregnant women and may help protect their infants against the virus. These revelations have not been enough to convince many pregnant women, however. According to the CDC, only about 40 percent of pregnant people in the US had been vaccinated against COVID-19 by the first of 2022.

“Pregnant persons are among those most in need of vaccines, but they are also among the most reluctant to get them,” says Dr. Denise Jamieson, James Robert McCord Professor and Chair of the Department of Gynecology and Obstetrics in the School of Medicine and professor of epidemiology. “As a clinician and an epidemiologist, I find it so frustrating.”

Social distancing requirements have proven extremely burdensome for pregnant women. “Pregnancy and having a new baby are times you want to share with your family and friends,” says Dr. Sarah Blake, associate professor of health policy and management. “Women tend to rely on their social network very heavily through this whole time. But during the pandemic, those networks closed down.”

Blake partnered with the Healthy Mothers Healthy Babies Coalition of Georgia to study the psychosocial impact of the pandemic on pregnant women and their families. The women she surveyed said it was extremely stressful to not be able to have their partner with them during prenatal appointments and ultrasounds. They also felt disconnected from their health care providers due to the COVID-19 precautions put into place by health care systems. One woman in Blake’s study described her disappointment during a prenatal health care visit, when her masked nurse stood in the corner six feet away, visibly uncomfortable, and rushed through the appointment, not allowing the woman to ask any questions about her care.

Almost half of the women in Blake’s study were not allowed to have their partner in the delivery room, and the others were limited to one person. One woman recalls the stress of having to choose between having her husband or her doula with her as she gave birth. The no extra person rule extended to postnatal visits, and women reported not being allowed to bring their newborns. One woman said that her husband had to take off work to watch the baby so she could go to the appointment. Others missed the visit altogether.

Group classes and in-person support, such as childbirth classes and lactation support, were curbed out of concern for spreading the virus. These losses were felt keenly. “We’ve always had very active group prenatal care at Grady,” says Jamieson, who practices at the safety net hospital. “We have given hospital tours to pregnant women, offered lactation support. All those services stopped or went virtual, and that has been hard on our patients.”

All of these changes have challenged pregnant and postpartum women’s mental health. In normal times, up to one in five women will suffer from a perinatal mood and anxiety disorder, such as postpartum depression. The last two years have not been normal times. About threequarters of the respondents in Blake’s study reported a rise in their stress and anxiety levels. More than a quarter reported very often feeling that difficulties were piling up so high they could not be overcome and that they could not cope with all the things they needed to do.

“This study was the first to track women’s experiences with psychosocial and maternal health care during the COVID-19 pandemic,” says Blake. “My hope is that it will provide important baseline information about how to strengthen maternal health care services and support for women in Georgia, which has among the highest rates of maternal mortality in the United States.” n

There are likely very few, if any, people who have escaped one fallout from the pandemic—a strain on their mental health.

“COVID has had a profound effect on pretty much everybody, from fears of getting sick, to transitioning to work from home, to kids being virtually home schooled,” says Dr. Benjamin Druss, Rosalynn Carter Chair in Mental Health. “Surveys have consistently shown high levels of anxiety and depression. Clearly COVID has had a major impact on people’s mental health.”

As with everything else in the pandemic, the impact on mental health has not been distributed evenly. “Some people reading this article may have had relatively few disruptions to their lives,” says Druss. “Others had their lives upended. These groups include essential workers, front-line health care providers, minority groups, and people with pre-existing mental disorders.”

Despite rising rates of depression and anxiety, suicide rates actually fell by about 2 percent in the US between 2019 and 2020. Experts are not sure why, but some speculate various financial support packages that were available early in the pandemic, along with a sense of “we’re all in this together” camaraderie, could have played a role.

Yet, one group that had an alarming change in suicidal behavior during the pandemic was teenage girls. In a group that had already been struggling mightily with marked increases in depression, anxiety, and suicidal behaviors before COVID-19 hit, the pandemic was fuel to an already hot fire.

Social isolation at an age when lives typically revolve around peers was devastating. Household anxiety about the virus, income, and other uncertainties were felt keenly by children and teens. And grief. More than 140,000 children in the US are estimated to have lost at least one parent or caregiver from mid-2020 through mid-2021, according to a report published in Pediatrics. Racial and ethnic minority children account for 65 percent of that number.

According to the CDC, the proportion of mental health–related emergency department visits among adolescents jumped 31 percent in 2020 over the previous year. A meta-analysis published in JAMA Pediatrics said depressive and anxiety symptoms among youth have doubled during the pandemic globally.

“The pandemic put so many stressors on everyone, but the mental

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health trends among youth prior to the pandemic were already very concerning,” says Dr. Janet Cummings, associate professor of health policy and management. “The situation among youth is now so dire it has become a true national health emergency.”

Indeed, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association issued a declaration of child mental health emergency in October. Two months later, the surgeon general issued an advisory report on youth mental health.

Cummings and her colleagues are in a unique position to provide assistance. Several years ago, the Substance Abuse and Mental Health Administration funded a network of technical assistance centers to disseminate evidence-based mental health practices around the country, including one at Rollins headed by Druss. The first order of business was to do a needs assessment of the region. “School mental health was at the top of the list for every one of the eight states in our region,” says Cummings, who is deputy director of the center. “And when we talked to education stakeholders, even before the pandemic, they said the No. 1 challenge they faced in improving and expanding their mental health programs was the shortage of mental health providers.”

So Cummings and her team have been partnering with schools even before the pandemic hit to address mental health. “Ours is the only technical assistance center in this network that is housed in a school of public health, so our lens is on systems-level change. Our team is providing programming and developing products to help school mental health leaders think about and come up with strategies related to funding and sustainability of mental health services.” n

It’s been called a shadow pandemic within the pandemic. Even before COVID-19, one in three women and girls worldwide were victims of intimate partner violence (IPV), including physical, sexual, and psychological abuse, during their lifetime. Though evidence confirms the incidence IPV has increased during the pandemic, the true extent was not known because the majority of cases go unreported.

Dr. Dabney P. Evans, associate professor of global health and behavioral, social, and health education sciences, set out to quantify the pandemic’s impact on IPV in Atlanta. “We know intimate partner violence increases during times of emergencies and natural disasters,” says Evans. “COVID-19 brought well-intentioned disease mitigation tactics like shelter-in-place orders. It also closed schools so children were at home with their parents, job and income loss, and anxiety about getting sick—a perfect storm for IPV. When the pandemic started, anecdotal reports were coming out of call centers, emergency rooms, and shelters indicating a surge in IPV, but there wasn’t a lot of systematic data.”

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Evans and her team first looked at police data for domestic crimes, many of which include IPV, and found an immediate uptick when the state’s shelter-in-place orders went into effect. The increase continued, however, even when the order was lifted. “We expected to see an increase corresponding with movement restrictions, but we also expected to see IPV rates go back to ‘normal’ once vaccines became available, the kids went back to school, and things returned to a ‘new normal,’ ” says Evans.

“But that didn’t happen. As the pandemic has continued it seems that we also have a ‘new normal’ for how often violence is taking place.”

Overall, Evans found an 11 percent increase in IVP in 2020 over the previous two years. And that, she cautions, is just the tip of the iceberg. Most cases of domestic violence are not reported to the police, meaning that these estimates still likely underestimate the problem.

Next Evans examined data from Grady Memorial Hospital and found a 17 percent increase in patients coming in for IPV during 2020 relative to the year prior. She also found a spike in first-time experiences of IPV. “When we spoke to survivors we learned more about why were were seeing this,” she says. “People talked about jumping into relationships quickly when shelter-in-place orders came along, so you’ve got a new relationship in a very stressful time. But we also saw people who had been in relationships for a long time with no prior violence come in after experiencing it for the first time, as well as worsening violence in relationships where IPV was already present.”

Evans also interviewed the health care providers treating victims of IPV, witnessing their distress as well. “One doctor said he was treating a woman with a broken arm,” she says. “He knew the break was the result of domestic violence, but he felt his hands were tied. He couldn’t admit her to the hospital—it was overflowing with COVID patients.

He could try to get her into a shelter, but they were overflowing as

Benjamin Druss and Janet Cummings, left, have looked at the pandemic’s impact on mental health.

Dabney Evans and Hannah Cooper, right, studied the fallout for intimate partner violence and substance abuse, respectively. Dean Curran joins them in front of the new R. Randall Rollins Building.

well. So, he felt the only option was to discharge her to a place that might not be safe. That kind of scenario is extremely hard for the health care provider and even more so for the survivor.”

The pandemic seems determined to linger, and likely others will follow. “Whether it’s COVID or a snow day in Atlanta, IPV increases whenever we have any type of emergency,” says Evans. “We need to scale up services, particularly safe interventions from hospital to community, to safely handle those cases. This is precisely where public health interventions can play a part”. n

For some, sadly, the path to coping with pandemic stress is drugs. According to a CDC report, as of June 2020, 13 percent of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19.

Between April 2020 and April 2021, 100,000 people died of drug overdoses, representing a 30 percent jump.

“As large as that number is, we know it’s just a tiny tip of the iceberg,” says Dr. Hannah Cooper, Rollins Distinguished Professor in Substance Use Disorders. “Depending on the drug, about 90 percent of people who experience an overdose survive it.”

The economic stress, social isolation, and general anxiety that has

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come with the pandemic has clearly prompted more people to start using drugs or to use them more often or in greater amounts.

At the same time, the albeit tattered safety nets that used to offer some protection for drug users have further unraveled.

“People who use drugs have a long history of supporting each other to help their survival,” says Cooper. “People often use drugs together for that reason. If one person overdoses, the other person does CPR, calls 911, or shares his Naloxone. The shutdowns and social distancing have disrupted all that.”

The pandemic also shuttered or disrupted services that substance users often count on, from food pantries and shelters to syringe exchanges and drug treatment programs. “These are all vital interventions, and they were all initially entirely shut down,” says Cooper. “When they reopened, they often operated with reduced staffing and greatly curtailed hours.

“COVID-19 and the resulting shutdowns were a major shock to the US system of harm reduction, and that has been keenly felt among those who use drugs,” she continues. n

The COVID-19 pandemic disrupted prevention and treatment across most, if not all, health conditions.

Some disruptions were unique to the particular disease, but invariably they were worse in racial and ethnic minority groups.

Just as COVID-19 disproportionately burdened Black and Hispanic/Latino communities, the havoc the virus caused in managing conditions from diabetes to mental health was felt mostly keenly in those groups.

Challenges already faced by communities of color—interruption in employment and insurance coverage, residential instability, transportation issues, and food insecurities, to name a few—were exacerbated by the pandemic, resulting in steeper declines in screenings, diagnoses, and treatments.

One potentially positive fallout of the pandemic—the rapid rise of telehealth—does not benefit everyone equally. Those without reliable, or any, internet or phone service are left behind, furthering the digital divide.

“We’ve always known that disasters affect vulnerable populations more than well-resourced ones,” says Cooper. “The pandemic has been no exception, dealing the biggest blows to those least able to handle them and widening already stark disparities. We must shore up programs and services that serve marginalized populations and make sure they are robust enough to weather future disasters.” n SPRING 2022 27

SORT

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When Emory made flu vaccines mandatory, SORT arranged two flu clinics at Rollins for students to get their shots.

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Student team has become valued partner in emergency and outbreak response

By Martha Nolan | Illustration by Joey-Guidone

n late January 2016, the Centers for Disease Control and Prevention (CDC) called on their Emergency Operations Center (EOC) to address the rising cases of birth defects due to the Zika virus. In response to the call to staff up the center, a member of the resource support section immediately said, “Can’t we SORT this?”

The CDC staffer was referring to the Rollins Student Outbreak and Response Team, a student-run organization that provides trained and committed volunteers to aid county, state, and CDC response efforts. Now in its 20th year, SORT has lent much-needed assistance in outbreaks and emergencies including the H1N1 epidemic, Hurricane Katrina, the Ebola outbreak, and the COVID-19 pandemic.

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SORT has become a strong attraction for prospective students, with some citing the organization as one of the main reasons they chose Rollins. SORT alumni have gone on to leadership positions in emergency and response units at the CDC and local, state, and federal agencies. And other schools of public health have used SORT as the model to establish their own student response teams. All of these accomplishments stem from the organization’s student members.

“I am the academic advisor for SORT,” says Dr. Allison Chamberlain, director of the Emory Center for Public Health Preparedness and Research. “But truly, I meet with the new presidents every year to welcome them, reiterate the organization’s mission, and let them know I am a resource and advocate for them. The students run the show. They don’t need a faculty member to make introductions for them anymore. They are known by their own reputation and name.”

Dr. Ian Williams puts it another way.

“The fact that SORT has become a verb at the CDC tells you all you need to know about how valuable and effective it is,” says Williams, the deputy director for the agency’s Center for Preparedness and Response.

A TEAM IS LAUNCHED The idea for SORT originated over two decades ago in the DeKalb County Board of Health (DCBOH). “We saw SORT both as a way to expose students to the complexities of realworld public health practice at the local level and as a way for us to have extra hands on deck in the event of an emergency,” says Sara Forsting 01MSPH, who was working as an epidemiologist with the DCBOH at the time.

Forsting found a receptive partner at the Center for Public Health Preparedness and Research, which was established after 9/11 with

a gift from the O. Wayne Rollins Foundation.

“It was immediately clear that this was going to be a great opportunity for our students,” says Dr. Ruth Berkelman, professor emeritus who led the center and served as the SORT faculty advisor until she retired in 2018. “I supported them, but it’s the students who get the credit. It’s amazing what the first groups of SORT students took on and the structure they established.”

SORT is intentionally a small, competitive group, admitting only a fraction of the interested students who apply. Students must apply for admission and commit to attending meetings, volunteer events, trainings, and selected classes.

“Many more students apply than get in,” says Berkelman. “Only the ones we think are the most committed make it.”

In the early years, SORT worked exclusively with the DCBOH, where students received training in preparedness and public health

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Amy Moskovitz, left, and other SORT students received BSL 4 laboratory training.

infrastructure, participated in tabletop to full-scale response exercises, and stepped in to help when the real thing hit. “I remember SORT students helping us with a large TB outbreak in a DeKalb County school, several foodborne outbreaks, and the West Nile virus,” says Ariane Reeves 07MPH, who helped establish SORT when she worked as a nurse epidemiologist at the DCBOH. When Hurricane Katrina hit in 2005, DCBOH called on SORT. “They were a key component of our response,” says Forsting, who is now back in school to become an environmental health officer in Canada. “As they landed those flights at Dobbins Air Force Base, SORT students were there to check them in, assess their needs, and help get them situated. They were very hands on at a very difficult time.”

TAKING IT TO A NEW LEVEL In 2008, Shauna Mettee Zarecki 09MN/MPH and Amy (Williams) Moskovitz 09MPH took over as co-presidents and, according to Berkelman, took SORT to “a whole new level.” Under their leadership, membership became limited to 30 to advance their training and specialization. SORT members were trained by the Red Cross to be certified disaster volunteers, and they were required to complete basic FEMA incident management and CDC EOC 101 trainings. In addition, many optional educational opportunities were offered, such as laboratory biosafety training and visiting a mock BSL 4 laboratory.

They re-established the Steering Committee composed of local and federal public health stakeholders to maintain a vision across the years and to have an active role in SORT’s path to ensure it remained valuable and relevant.

Zarecki also established the group’s first ties with the CDC, which included getting CDC badges for all team members so trained SORT students could quickly respond if needed by CDC. Initially, SORT 30

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students worked with the foodborne outbreak division, which at the time was headed by Williams.

“It was important to us that SORT students would not be ‘response tourists,’ but rather true assets to the organizations they served,” says Zarecki.

After graduating from Emory, Zarecki joined CDC’s Epidemic Intelligence Service in 2009 as a nurse in the US Public Health Service.

Dr. Ruth Link-Gelles 10MPH, now Lt. Commander in the US Public Health Service and a CDC epidemiologist, remembers manning the CDC Emergency Operations Center (EOC) when she was a SORT member.

“With foodborne outbreaks, if you had 40 cases, you might need to contact two to three times that number of controls, or people who had eaten at the same place but did not become ill,” says Link-Gelles. “We’d have SORT members in the EOC at all hours of the day and night and on weekends to make sure we could reach people when they were home. Usually, our job was to call the cases and controls and do lengthy interviews to narrow down the exposure of interest for a given outbreak.”

EBOLA AND THE SUPER BOWL When H1N1 hit in 2009, SORT members moved beyond foodborne outbreaks to help with the response. Since then it has responded to myriad outbreaks and emergencies, perhaps none as fearsome as the Ebola outbreak in 2014. As the hemorrhagic fever sped across West Africa, the CDC called an all-hands-on-deck, which included SORT. All SORT members, numbering 45 at the time, were tasked with helping update sparse or nonexistent maps of remote African villages so troops on the ground, such as Doctors Without Borders, could find and respond to localized outbreaks.

“The CDC trained all of us in using an open street mapping platform

to examine satellite imagery on a very granular level, zooming in on senior emergency preparedness officer of the FCBOH at the time. “She a small section and identifying what we thought were houses, roads, helped us tremendously in onboarding people and coordinating the ponds, etc.,” says Anna Tate 15MPH, who was communications chair of volunteer efforts. And it was a huge task. Everybody wanted to help with the COVID-19 efforts. From January 13 to February 9 last year alone we SORT at the time. “Once we tagged something, it was uploaded in real time. We all took this very seriously and spent hours and hours working averaged 421 people signing up every week.” on it. We were honored to be able to play a part in the response.”

At Emory, SORT members sat on the Rollins leadership COVID In 2019, when the Super Bowl was coming to Atlanta, the Fulton response committee, helped with contact tracing and case investigations, County Board of Health (FCBOH) decided it needed to revitalize its and coordinated a flu clinic.

“When Emory made the flu vaccine mandatory, we arranged to set up a medical reserve corps (MRC), which had been inactive for several years. flu clinic at Rollins so students could easily get their shots,” says Harton, who MRCs were established after 9/11 to train and vet banks of volunteers is pursuing a PhD in epidemiology at Rollins. who could be called up in the event of emergencies.

“We provided 213 flu vaccines to students “The emergency during the fall of 2020.” preparedness team in Fulton County was POISED FOR THE FUTURE seven people,” says The ability to meaningfully participate in Wendy Smith, then responses like these is a powerful draw for emergency preparedness prospective students. “I came to Rollins in administrator for the large part because of SORT,” says Zarecki.

“I was looking at several different schools, FCBOH. “About 500,000 and SORT made a big difference.” people were going to be attending the Super Bowl.

That allure is just as strong today as We needed to revitalize it was when Zarecki matriculated. Current our MRC unit in the event SORT co-president Joel Espinoza MPH23 of an emergency.” credits the organization with drawing him to Rollins. “SORT was a big reason SORT played an active role in that revitalization.

I applied to Rollins in the first place,” he says. “I wanted to be president because SORT leaders were given I wanted to help shepherd it through the two positions on the next year. I believe my experience with steering committee, which SORT students are offered complete CPR training when involved brainstorming SORT will be a real professional leg up they join the team. on what the MRC unit when I go to look for a job.”

And that’s exactly what many past should look like and how it should function. They helped with communication, volunteer recruitment, SORT leaders have found. Zarecki is now a commander with the volunteer training, and management plans.

US Public Health Service in CDC’s Center for Preparedness and When the Super Bowl arrived, SORT leaders worked in the FCBOH Response Situational Awareness Branch and has deployed more than 12 times for the COVID-19 response alone. Link-Gelles is the program EOC throughout its 10-day activation as liaisons for the volunteers. “And not just the SORT volunteers, but all the volunteers,” says Smith, who is lead for the CDC’s COVID-19 vaccine effectiveness team. Tate is an now an emergency management specialist at the CDC. “I’m not sure how interdisciplinary scientist in the Office of Preparedness and Response at the US Department of Health and Human Services. we would have done it without them.”

“I worked on the H1N1 outbreak when I was with SORT,” says LinkGelles. “My first position at the CDC was in the bacterial respiratory PANDEMIC RESPONSE disease branch, and I basically was able to get that position—fresh out During the past two years, SORT, like almost every public health of my MPH—because of the experience I gained through SORT.” and health care organization, has focused nearly all of its efforts on responding to the COVID-19 pandemic. SORT members have worked With such success stories, the student organization that was founded 20 years ago seems well positioned to last well into the future. “It means with the DCBOH, FCBOH, CDC, and the Georgia Department of Public so much to me to see SORT so vigorous and strong and yet able to adapt Health, helping with volunteer management and operations for testing and vaccination sites, including the massive effort at Mercedes-Benz to the public health priorities of the moment,” says Zarecki. “It is just Stadium. Paige Harton 21MPH, who was a SORT co-president in 2020, amazing when people tell me that the reason they selected Emory for their public health degree was because of SORT, and it speaks to the served as the COVID-19 SORT volunteer coordinator for the FCBOH. “Paige had so much institutional knowledge about how Fulton quality of the SORT experience to see what SORT alumni have gone County and our MRC worked,” says Corinna Hansen 09MPH, who was on to accomplish.” n SPRING 2022 31

THE FUTURE STARTS HERE Emory’s new campaign aims to transform the future

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mory University has launched its most ambitious campaign to date to raise $4 billion to advance its mission of serving humanity through knowledge.

Named for Emory’s bicentennial, 2O36 is about investing in people for the benefit of people.

“When there is an important issue, a tough question, I want them to think, ‘I wonder what’s going on at Emory? I wonder how they’re solving this? I wonder what research is addressing this question,’ ” says University President Gregory L. Fenves.

Emory kicked off the community phase of its visionary 2O36 campaign in late October 2021 with events on the Emory Quad. Five geodesic domes and a grand stage were erected to tell the stories behind the campaign. Dean Curran and other deans and administrators shared their priorities for the future of Emory.

Dr. Briana Woods-Jaeger, assistant professor of behavioral, social, and health education sciences, discussed her work regarding stress and trauma-related health disparities in mental health in collaboration with community partners in Atlanta and across other regions.

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The work of Dr. Rachel Waford Hall, a clinical psychologist and assistant professor in global health, which centers on identifying and helping young people with psychosis get into treatment, was also featured.

The university had already raised $2.6 billion through the preceding four-year silent phase of the campaign. It now hopes to raise the remaining amount over the next three years.

In addition to supporting priorities across all nine of the university’s schools, multiple centers and institutions, and Emory Healthcare, the campaign will place special emphasis on three core areas—student flourishing, faculty eminence, and research excellence.

Central to all of these goals is increasing Emory’s endowment. Endowed scholarships to ensure that cost doesn’t deny top students the benefit of an Emory education. Endowed

faculty positions to enable the university to continue to attract and retain the most talented and accomplished faculty in their fields.

And endowed funds earmarked for research to answer the most pressing questions and address the crucial needs of tomorrow.

The campaign is guided by a Campaign Council led by Susan Cahoon 68C, John and Cammie Rice, Sarah Beth Brown 89B, Adam Rogers 92C 96M P19 P21, and Stephanie Rogers 92C P19 P21. Amy Rollins Kreisler, Mary Ann Lanier, and Melissa Lowe serve on both the university Campaign Council and the Rollins Campaign Committee.

“If we boldly invest in student flourishing, faculty eminence, and research excellence, Emory will contribute as never before,” says Fenves. “And the 2O36 campaign will empower our students, faculty, and staff to accomplish our mission: service to humanity. The future at Emory starts now.”

2O36 AT ROLLINS Rollins had already raised $208 million by the time the futuristic domes were erected on the Quad. A very generous gift of $65 million for the R. Randall Rollins Building enabled the school to meet one of its highest campaign

Landmark $100 million gift Leaders from Emory and the Rollins Foundation celebrated a transformative $100 million gift from the O. Wayne Rollins Foundation. They include (from left): Jonathan S. Lewin, Emory executive vice president for health affairs, Woodruff Health Sciences Center executive director and Emory Healthcare CEO; John Rice, Emory University Board of Trustees; Pam Rollins, O. Wayne Rollins Foundation trustee; James Curran, dean of Rollins School of Public Health; Amy Rollins Kreisler, O. Wayne Rollins Foundation executive director; Emory President Gregory L. Fenves; Timothy C. Rollins, Emory University Board of Trustees and O. Wayne Rollins Foundation trustee; M. Daniele Fallin, incoming dean of Rollins School of Public Health; Robert C. Goddard III, Emory University Board of Trustees chair; and Ravi V. Bellamkonda, Emory provost and executive vice president for academic affairs.

ROLLINS CAMPAIGN COMMITTEE priorities. Thirty donors have established their own endowed scholarship funds through an innovative scholarship-matching initiative that matches gifts ranging from $50,000 to $125,000 on a one-to-one basis. This program has added almost $22 million to the Rollins endowment.

Rollins has been focused on building a strong endowment for more than 25 years. Great strides were made toward this goal when shortly after the campaign launch, Rollins received the largest gift in the school’s history. The O. Wayne Rollins Foundation committed a landmark $100 million gift to create two new endowed funds, the Rollins Fund for Faculty Excellence and the Rollins Fund for Student Success.

The Rollins Fund for Faculty Excellence will be dedicated to recruiting and retaining exceptional senior faculty by nearly doubling the number of the school’s endowed faculty positions and by providing early career support for Rollins assistant professors.

Faculty are crucial to achieving success securing millions of dollars each year from private foundations and corporations including the Bill & Melinda Gates Foundation, the Ray C. Anderson Foundation, the Robert W. Woodruff Foundation, the Robert Wood Johnson Foundation, Giliad, and many others.

The Rollins Fund for Student Success will be used to increase the number of merit scholarships given to public health students. This fund may also provide students with career-enhancing experiences through the Rollins Earn and Learn work-study and global field experiences.

“This campaign will allow Rollins to achieve transformative advances by attracting top-tier students and stellar faculty,” says Curran. “It will fuel ground-breaking research. Investments in our school through the 2O36 campaign will have a wide ripple effect, improving the health and well-being of populations around the globe.” n

Rhona Applebaum, PhD Ami Shah Brown 00PH, PhD Bruce Brown 01PH, MA Lisa Carlson 93PH, MCHES Bert Clark Jr., JD Alisa Golson 98PH Johanna Hinman 98PH, MCHES Amri Johnson 96PH Ann Estes Klamon 65C 76JD Amy Rollins Kreisler, JD Mary Anne Lanier Melissa Lowe David Martin, RN Michael Ugwueke 86PH, DHA, FACHE

ROLLINS ALUMNI CAMPAIGN COMMITTEE Amri Johnson 96PH – Chair Anne Arwood 06PH 20B Carmen Ganga 12PH Keisha Hunt 03PH Heather Ingold 00PH Emily Kraus 08PH Angie McGowan 98PH Melissa Miller 04C 06PH Cheryll Thomas 99PH SPRING 2022 33 SPRING

Celebrating service and leadership Rollins alumni receive three of five top Emory honors

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school’s curriculum. The organization aims to break two large barriers ach year, Emory University honors outstanding alumni for Black children learning to swim: access and affordability. Miller is with awards celebrating their achievements in service shining a light on the racial disparities and health inequities that have and leadership. The Community Impact Award recognizes persisted for generations. With each lesson given at SwemKids, she is alumni who, whether through professional or volunteer service, have made envisioning a new way for Black communities to approach swimming. significant and positive impact on the lives of others and embody the values represented in the university’s vision. The J. Pollard Turman Alumni Service Award is given to an alumnus/a who demonstrates exceptional volunteer J. POLLARD TURMAN ALUMNI SERVICE AWARD leadership. This award comes with a $25,000 gift from the Tull Foundation, LISA M. CARLSON 93MPH has spent the last three decades dedicating which the recipient can her life to public health and direct to any Emory school, Emory. She first came to division, or program.

Emory in 1992 as a first-genThe highest of all alumni eration college student and awards, the Emory Medal Woodruff Scholar. Carlson honors its recipient for credits the effortless sense service to Emory, service of community she found as to the community, and a student, her successful achievement in business, career, and her marriage the arts, the professions, to fellow alumna, Johanna government, or education.

Hinman 98MPH, as the Due to an overwhelming reasons why she’s stayed so number of candidates, two closely tied to the university.

Community Impact Awards Carlson carries dual roles and two Emory Medals at Emory as an affiliated Lisa M. Carlson, Trish Miller, and Jean O’Connor (l-r) were honored with Emory were given this year. instructor at Rollins and exUniversity’s top recognition for alumni.

Of the five 2022 ecutive administrator of reawardees of Emory’s top honors for alumni, three hailed from Rollins. search administration at the Emory School of Medicine. She has inspired Let’s meet the winners. hundreds of students to think critically about today’s public health issues while championing public health on the national level. Carlson has served as president of the American Public Health Association and made history COMMUNITY IMPACT AWARD as the youngest president to be elected to the Georgia Public Health TRISH MILLER 17MPH was 19 years old when she dove headfirst into Association. She has made it her mission to serve Emory in a multitude of 12-foot-deep water. It was spring break, and after a 15-minute swim lesways, from committees and boards to fundraising and individual giving. son from friends, she mustered the courage to take the leap. Adrenaline A former president of the RSPH Alumni Board and member of the Emory soaring, her body crashed into the water. It was a frantic few moments Alumni Board, a perennial mentor, speaker, and panelist, Carlson never before Miller realized that she had no idea how to float or tread water. declines an opportunity to share her knowledge and experience with Luckily, her friends sprang into action and saved her life. She went on to others. She was instrumental in raising funds for Rollins during Camlearn that experiences like hers were far too common. In fact, drowning paign Emory and is again guiding fundraising efforts through the 2O36 deaths are the second-leading cause of death in children 17 and under. campaign as a member of the RSPH Campaign Advisory Committee.

For Black children, the rates are even higher than for their Hispanic and She also leads the effort to endow a scholarship in honor of Dr. Nancy white counterparts. Faced with her own experience and alarming statisThompson to support student thesis projects at Rollins. Her lifelong leadtics, Miller knew what she had to do. In 2017, she founded SwemKids. The ership, service, and mentorship at Emory and beyond is truly remarkable, school-based water safety and swimming instruction program transports embodying the service and commitment to Emory and the community elementary and middle school students to local pools as part of their

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ALUMNI CONNECTIONS at large that the award was created to recognize. Carlson has paired personal gifts from her wife, herself, and their parents with the $25,000 gift from the Tull Foundation to create the Hinman-Carlson Family Scholarship, which will benefit MPH students at Rollins.

CLASS NOTES

1900s

THE EMORY MEDAL DR. JEAN O’CONNOR 98C 01L 01MPH has spent more than two decades as a public health leader ensuring communities are healthy— and stay that way. She previously worked for the State of Georgia as the chief policy officer and chronic disease prevention director. In that role, she oversaw $30 million in statewide grants and programs related to risk factors for chronic disease, health equity, the state’s health improvement planning process, and partnerships across sectors. She also worked at the Centers for Disease Control and Prevention for 10 years as a health scientist and was the acting associate director for policy for the Center for Preparedness and Response. She has taught at Rollins since 2003 and the doctoral program at the University of Georgia since 2017. While working and teaching, she earned a doctor of public health in 2009 from the University of North Carolina at Chapel Hill. O’Connor has always been deeply committed to public service. She’s the past-president of the US National Association of Chronic Disease Prevention Directors and serves on several nonprofit boards, including Heluna Health. In 2018, she was named to the Fulbright Specialist Roster for global health and law. The same verve O’Connor has committed to public service has kept her involved with Emory. While attending Emory, she volunteered extensively for Emory EMS, and she has continued to contribute to many committees, organizations, and groups during the past 25 years. n

IN MEMORIAM

1900s

PERRI ZEITZ RUCKART 98MPH of Atlanta received a doctor of public health degree from the University of Georgia on December 17, 2021. She is an epidemiologist at the CDC’s National Center for Environmental Health and has previously worked for the US Department of Health and Human Services’ Agency for Toxic Substances and Disease Registry.

2000s

GORAN ABDULLA SABIR ZANGANA 09MPH is a medical doctor and associate research fellow with the Middle East Research Institute in Iraq. He is a Healthcare Information for All (HIFA) country representative for Iraq and is currently based in the United Kingdom. In January 2022, Zangana was named the HIFA Country Representative of the Year for 2021. HIFA is a global human rights based community of more than 20,000 members committed to improving the availability and use of reliable health care information and protecting people from misinformation.

2010s

MARRIED: JOSEPH M. GERTH 16C 18MPH and SARAH E. SEYLER 15B of Boston were marred October 22, 2021, in New Orleans, La. Gerth is a surveillance epidemiologist with the Massachusetts Department of Public Health, and Seyler is a principal associate with Education Resource Strategies.

STACEY ROBIN HILL 89A 91MPH of Kennesaw, Ga., on February 24, 2022. Hill was born November 30, 1966, in Monticello, NY. She earned an MPH in 1991 and had a successful career as a pharmaceutical sales representative and registered dietician. She is survived by her two daughters Samantha Hill and Sarah (Hill) Dagher, son-in-law, mother, father, and step-mother.

2000s

JAMIE L. MILLER 01MPH of Richmond, Calif., on December 7, 2020. Miller worked for 37 years at the CDC as a public health advisor.

She was one of the first women to be hired as a public health advisor and was assigned to local and state health departments in many locations before joining the California Department of Public Health in 1988 where she worked until her retirement. Miller twice served as co-chair of the Contra Costa County Juvenile Justice Commission, volunteered as a writer’s coach at Richmond High School, was a docent at the Rosie the Riveter National Park, and served as annual dinner co-chair of the development committee for the Rosie the Riveter National Trust. She died from complications of a rare stomach cancer and is survived by her husband, Stephen Purser, a brother, and many nieces and nephews.

RONALD PRESTON PETERSON 07MPH on February 28, 2022. Peterson was a member of St. Bartholomew’s Episcopal Church in Atlanta and previously of St. Edward the Confessor Episcopal Church in Lawrenceville and St. Matthew’s Episcopal Church in Snellville. He graduated from Berkmar High School in 1987 and left for St. Andrew’s Presbyterian College in Laurinburg, NC, where he earned a degree in chemical physics and mathematics. He continued his advanced education at the University of Tennessee in Knoxville where he held a teaching assistant position in the chemistry department. He earned an MS in computer science from Georgia Institute of Technology and an MPH from Rollins even as he began his 26-year career at the CDC as a computer specialist. He is survived by his parents.

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CONTRIBUTIONS

A champion of the world’s newborns

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oy Lawn’s connection with newborn survival is personal. She was almost a newborn casualty when her mother had an emergency cesarean delivery in a remote bush hospital in northern Uganda and was saved by a medic who had done surgery before but not a cesarean.

“From an early age, I was motivated by social justice issues,” Lawn says. “Living in Uganda until I was a teenager had a lasting effect, despite close experiences with President Idi Amin, and then moving to Belfast during the Troubles.”

Lawn 00MPH is now director of the Maternal, Adolescent, Reproductive, & Child Health (MARCH) Centre at the London School of Hygiene & Tropical Medicine and one of the world’s leading experts on global perinatal data and evidence. She was responsible for the United Nation’s first authoritative national and global estimates on many major perinatal outcomes—2 million stillbirths, 2.5 million neonatal deaths, and other relevant measurements. She has led several Lancet series, one of which catalyzed the first SDG (sustainable development goal) on neonatal survival.

Though she has traveled far, she never left her African roots behind.

Lawn chose a medical school in Nottingham, UK, where she could complete an intercalated degree in epidemiology in western Kenya studying the experience of pregnant women.

After her medical degree, she trained in pediatrics and neonatal health, intentionally gathering those special skills to return to African countries. She met and married a fellow medic who specialized in TB and AIDs. Spurred by the desire to enable African-led change within African learning communities, Lawn chose to teach and practice at a large hospital and medical school in Ghana on a local wage rather than sign on with a more prestigious, white-led research institution. “The experience was very formative,” Lawn says. “We daily saw newborn babies who were dying who shouldn’t have died. At that stage there were no global numbers of newborn deaths, almost no WHO guidelines mentioning newborns, and it was impossible to get any funding.”

In 1997, Lawn and her family moved to Atlanta, where she was a fellow at the Centers for Disease Control and Prevention’s (CDC) WHO Center in Perinatal Care and Health Services Research while she earned an MPH in global health.

“Very early on I met several heroes of global health at Rollins,

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including Deb McFarland, Stan Foster, and Bill Foege,” says Lawn. “These mentors and the classes I took really shaped me. I was incredibly fortunate to receive the Woodruff scholarship. I would have never been able to afford that master’s degree without it.”

She recalls a highlight from her experience as a Rollins student. “Bill Foege ran a small class of about 12 students on global health leadership, and it truly inspired me both to believe you can make change, but also seeing a pathway to make it,” Lawn says. “Even years later, I still process things I learned from him. He was incredibly humble, yet so insightful of global health architecture and politics.”

Lawn’s time at Emory and the CDC was a turning point in her career.

Her newfound skills helped her to better generate the global data needed, design large-scale research, and navigate policy change within national and global health structures.

“Something can be a big problem, with a huge number of deaths, but change on the global agenda is also influenced by framing it in a way that is personal and actionable,” Lawn explains.

Most of the global evidence for newborn health care at that time focused on high-income countries, in intensive care units with expensive equipment.

At that point 60 million of the world’s births were still at home in Africa or South Asia and saving such lives was considered too hard.

“Getting the evidence and making a case for community-based interventions was a critical shift then. Now 20 years later, we are making another big shift,” says Lawn. “Now, we are able to transform hospital systems in low-income countries for newborn care with a bundle of innovative devices and large-scale programs such as NEST360, an international alliance aimed at ending preventable newborn deaths in African hospitals.”

Lawn was honored to receive Emory’s Sheth Distinguished International Alumni Award in 2015.

Lawn was humbled by the award and the experience. “I was overwhelmed when they gave me a standing ovation,” she says.

It was well deserved.—Camile Matthews

Would you like to share your story or nominate someone to feature?

Let us know with an email to the editor: martha.mckenzie@emory.edu Photo credit: Helen Jones

Rollins School of Public Health Dean’s Council Melissa H. Lowe, Chair Ms. Angela Z. Allen Dr. Rhona S. Applebaum Ms. Yetty L. Arp Dr. Raymond Bain Mr. Chris Barker Ms. Constance Barkley Lewis Ms. Paula Lawton Bevington Dr. Celeste Bottorff Ms. Susan M. Boyd Dr. Ami Shah Brown Mr. Bruce Brown Mr. Jason Carter Mr. Bert Clark Dr. Marlene Cole Ms. Connie Cousins-Baker Ms. Sally A. Dean Dr. Walter C. Edwards Dr. Brenda C. Fitzgerald Ms. Pegi Follachio Dr. Sandra Ford Mr. Jonathan Golden Ms. Alisa Golson Ms. Leslie J. Graitcer Mr. Shelby R. Grubbs Mr. John B. Hardman

Ms. Kathy Harkey Ms. Virginia Bales Harris Ms. Gail Hayes Mr. Richard N. Hubert Ms. Ellen Hale Jones Ms. Randy Jones Mr. Stanley S. Jones Jr. Ms. Anne H. Kaiser Mr. Mark A. Kaiser Mr. Alfred D. Kennedy Dr. William Kenny Ms. Ann Estes Klamon Ms. Amy Rollins Kreisler Ms. Mary Anne Lanier Ms. Barbara W. Levy Ms. Melissa H. Lowe Mr. Carlos Martel Jr. Mr. David A. Martin Dr. Barbara L. Massoudi Mr. Michael Melneck Ms. Mary Lu Mitchell Mr. John S. Mori Mr. Horace Disston Nalle Ms. Nancy McDonald Paris Dr. Rajan Patel

Mr. Cecil M. Phillips Mr. Glen A. Reed Dr. Cindy Reedy Mr. Gary Reedy Ms. Teresa Maria Rivero Ms. Patricia B. Robinson Ms. Donna C. Rohling Ms. Kathleen W. Rollins Dr. Nalini R. Saligram Dr. Dirk Schroeder Dr. John R. Seffrin Ms. Jane E. Shivers Ms. Margaret Stagmeier Ms. Sandra L. Thurman Mr. William J. Todd Dr. Kathleen E. Toomey Ms. Linda Torrence Ms. Sheila L. Tschinkel Dr. Michael Ugwueke Dr. Jennie Ward-Robinson Ms. Arlene Warshaw Dr. Walter B. Wildstein Dr. Shelby R. Wilkes Ms. Melody Wilder Wilson

Dr. James W. Curran, MD, MPH, James W. Curran Dean of Public Health Ms. Kathryn H. Graves, MEd, MPH, Senior Associate Dean for Advancement and Alumni Engagement

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EMORY UNIVERSITY ALUMNI RECORDS OFFICE 1762 CLIFTON ROAD ATLANTA, GA 30322

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reate your lasting legacy at Rollins by purchasing a seat in one of our two tiered classrooms in the R. Randall Rollins building when it opens this fall.

With a one-time gift of $500, your name—or that of a respected colleague, mentor, professor, student, or loved one —will be engraved on a 5-inch by 1-inch brushed stainless steel dedication plaque.

Each plaque will be displayed on the front edge of the classroom tables to ensure the most prominent and permanent placement.

Your gift to the Seating Our Future Campaign will support students through scholarship, unless otherwise directed. Help us shape the future of public health by seating the next generation of public health leaders.

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ROLLINS MAGAZINE

For more information, please contact us at 404.727.3739 or sphalumni@emory.edu.