Public Health Newsletter
Fall 2014, Volume 5
The Bridge is a public health newsletter written and produced by Hofstra University students and faculty devoted to bridging the gaps in our health care system and improving the health of our communities.
The Many Sides of Ebola: Understanding the Health, Culture and Political Factors Involved in the Ebola Epidemic in West Africa By Berlinda Olivier, MPH ’15 On Wednesday, November 5, 2014, Hofstra University began its month-long lecture series on the global Ebola outbreak. The series featured discussions led by several professionals in the fields of Public Health and Biology who each offered valuable insight into the virus and the global challenges associated with this current outbreak. While there are very few cases of “imported” Ebola in the United States — cases in which people were infected outside the U.S. and carried the disease here — one case has resulted in death, which in turn served to heighten public awareness, anxiety and fear about the disease. Dr. Tefera Gezmu, Assistant Professor at the Edward J. Bloustein School of Planning & Public Policy at Rutgers University, o red the first talk of the lecture series and explained the crucial differences between an Ebola outbreak in the U.S. and those that have occurred in West Africa. Violence and civil war have raged over the last three decades in many coastal West African countries and as a result, countries in the Global North seized the opportunity to exploit farmers in impoverished areas of Liberia and Sierra Leone through land grabbing, with the ultimate goal of developing international trade and businesses. As a result, lands are leased but taxes aren’t paid which negatively affected the infrastructure development in these countries. In addition, political misconduct has left many Africans with little means to feed and support their families. Forced to find other ways of making a living, many Africans are led to “hunt bush meat,” which involves handling fruit bats, monkeys and other animals that are the suspected sources of the Ebola virus. For years, African hunters have been handling bush meat without exposing themselves to the Ebola virus because they developed a mild resistance, which is evident in the presence of antibodies in their bloodstream.
In addition to factors related to poverty and a stricken political economy, Dr. Gezmu also explained that many of the causes of the outbreak of Ebola in West African countries are linked to cultural beliefs and traditions (e.g., burial practices which require bathing the deceased when the body is most infectious) and mistrust of both local governments and international aid workers, which has slowed down the disease control efforts. Furthermore, challenges within many West African countries’ already weak healthcare systems have caused this disease to have more deadly effects in places like Guinea, Sierra Leone, and Liberia than it does in other countries. continued on page 2
Inside The Many Side of Ebola (cover page) …..…..…..…..…..…..…..…..…..…... 1 From the Director …..…..…..…..…..…..…..…..…..…..…..…..…..…..…..……. 2 How Can Communities and Research Get Along?.……………..…..…..…. 3 The impact of the Work Environment on Obesity ………….…..…..…….. 3 Interview with Dr. Anthony Santella …………………………………………….. 4 Effects of Geography on Health: HIV in Africa ……………………………….. 6 Bringing a Public Health Message to VOICE Day ……………………………. 6 Containing the Dengue Epidemic in South Asia ……………………………... 7 The Killer in the Shadows: have We Forgotten Infectious Disease? … 8 The American Public Health Association's 12nd Annual Meeting ………… 9
Ethics Exchange ……………..…………………………………………………………….. 9 SOPHA’s Corner …………………………………………………………..………………. l0 MPH Photo Recap …………………………………………………………..……………..l0 For More Information …………………………………………………………………. 11
From the Director The Hofstra MPH community enjoys a traditional New Orleans dinner
Dr. Corinne Kyriacou, PhD, MPH Associate Professor Graduate Director MPH and MSCH Programs Department of Health Professions Hofstra University I’ve just returned from the annual American Public Health Association (APHA) meeting in New Orleans, and I’m excited to share news of our program’s public health adventures in Louisiana. As the nation’s leading public health organization, APHA strengthens the impact of public health professionals by promoting “health in all policies;” building partnerships, coalitions and connections with people outside the public health community; through science-based advocacy and programs; by bringing public health professionals together to share new ideas and best practices; by publishing the premiere public health journal and other educational materials; and, by building public health infrastructure and capacity. With over 1000 presentations and more than 12,000 attendees, APHA’s annual meeting is indeed the public health event of the year. We were therefore thrilled that coupled with generous support from Hofstra’s National Center for Suburban Studies, our MPH program was once again able to subsidize seven current MPH students so they could attend the meeting, along with three new MPH alumni and two additional MPH faculty members. In addition to the usual excitement at being immersed in a sea of enriching, inspiring and innovative public health research and program reports, attending the conference with a critical mass of students, alumni and
faculty from Hofstra’s MPH program was invigorating and gratifying. While our program is new--we just accepted our third cohort this September and graduated our first cohort this past May--I watched with pride as our group of 13 students presented, learned, and networked with public health professionals from around the country and world. I was transported back to my graduate school days as I watched our students stroll among the poster sessions, entranced by both the developing studies and by the promise that they would soon be among the presenters. I remember my first time leading a roundtable discussion as I listened to one of our own students respond to questions with a combination of anxiety and urgency in her voice. And I reveled in hearing our students bubble over with excitement after a session where everything clicked and they decided, seemingly in an instant but built on months of getting ready for the “A-HA” moment, what they wanted to focus on for their culminating experience. With great optimism I watched our new alumni exchange business cards with colleagues, discuss how they’re applying their newly honed skills in their current positions, and offer guidance to the current students. And, I was filled with satisfaction and continued confidence in the direction our program is taking as I observed my faculty colleagues mentoring our students, engaging in their own professional development and sharing their exciting research with the larger community. (For a student perspective on APHA please see the article by Pascale Frederique.) Of course, attending APHA is only one of many milestones our MPH program has achieved since our last issue of The Bridge. As I mentioned above, we graduated our first cohort, hired a new full-time faculty member (see interview by Eugenia Boye-Codjoe), secured dates for our Council on Education in Public Health (CEPH) accreditation site visit,
In health, Corinne Kyriacou
continued from page 1
The Many Sides of Ebola This in turn created fear amongst the population, as well as serious resistance to seeking help. Fighting this fear as well as the stigmatization surrounding the Ebola virus are among the greatest challenges healthcare workers in West Africa face. Additionally, the measure of sending international soldiers into remote communities to enforce quarantine restrictions was counterproductive and further added to public fear. A better approach might involve asking influential religious lead-
enrolled our third cohort of 21 new students, held special lectures on Ebola and CommunityBased Participatory Research (see articles by Berlinda Olivier, Martine Hackett and Isma Chaudhry), assisted in the implementation of a major health fair (see article by Saeyoan Thiru), ran two journal clubs and a number of professional development trainings, and, we are now preparing for our annual MPH Poster Session and Graduating Student Symposium, both of which will take place during the last week of the semester. Inside this issue you will also find articles reporting on international health initiatives (see articles by Shaanan Meyerstein and Akshat Jain), and how the workplace can put us at risk for obesity (see article by Aditya Bissoonauth). We also have two new sections in this issue of The Bridge that we plan to run in every issue moving forward: Ethics Exchange (see article by Isma Chaudhry and Pam Lefkowicz) and the SOPHA Corner (see article and pictures by members of SOPHA’s Executive Board). This issue also marks our first time organizing a Student Editorial Committee, chaired by Abdul Moiz Qadri, MPH ’16, and including Kemar Trowers, MPH ’16 and Saeyoan Thiru, MPH ’15. Further, many of the photos in this newsletter were provided by Thalia Stewart, MSCH ’15. In all, 15 students (including one alum) wrote for this edition of The Bridge. It’s an impressive accomplishment that paints a fascinating picture of Hofstra’s thriving MPH program, and it’s informative as well! I encourage you to read through the many interesting articles and also explore our ever-evolving website that now includes more student and alumni videos, newly archived public health faculty webinars and sample student work.
ers within affected communities to help convey the importance of making changes for the sake of stopping the spread of the disease. And certainly, more public health intervention in West Africa is necessary to help affect outcomes. Three additional lectures were held in the weeks following Dr. Gezmu’s talk to continue the dialogue around clinical, biological and healthcare system challenges at the international, na-
tional and local level and to examine communication and ethical issues in both treatment and prevention of this deadly disease (see Hofstra News Website for more details). The Master of Public Health program and the student Society of Public Health Advocates have also been collecting donations to help the CDC Foundation fight the Ebola crisis in the developing countries.
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How Can Communities and Researchers Get Along? By Martine Hackett, PhD, Assistant Professor, MPH Program & Isma H. Chaudhry, MD, MPH’15 Public health professionals recognize the need to engage and involve the communities we research and serve. While recognition is necessary, however, it is not sufficient when it comes to creating real partnerships with the public to improve health outcomes. Think of recent attempts in New York City to regulate soda sizes that failed in part due to lack of acceptance, understanding and a legitimate buy-in from the communities that would have been affected the most. This type of disconnect --between what researchers want to do and what communities members need--was the motivation behind an event held on November 13, 2014 titled, “Bridging Community and Academic Research: What’s In It For Us?” The event was organized through the Community Participatory Research Committee of Hofstra’s Center for Civic Engagement and supported by a grant from the Hofstra Cultural Center. Guest speaker Barbara Katz Rothman, a professor of sociology and public health at the CUNY Graduate Center in New York City was invited to present her experiences and critiques of the benefits and barriers that can occur when researchers and community members work together. Speaking to an audience of undergraduate and graduate students as well as local community residents, Katz Rothman presented provocative examples from over 30 years of research experience in the fields of women’s health and human genetics, and offered vivid examples of how the involvement
of community members in large scale research projects can be problematic when it is difficult to even agree who the “community” is. Katz Rothman called herself a pessimist, but the impression she left on audience members was that of an upbeat visionary who has challenged the world of academic research. She said that considering the history of the ethics of bioresearch, it is perfectly logical for local communities to be hesitant and skeptical of researchers and their research models. She argued that community members should ask pertinent questions about the research they intend to participate in and evaluate their interests in the given project. Katz Rothman’s warnings reflect the history behind the relationship between the researcher and the researched and the real movements that have sought to dismantle this top-down approach to understanding and addressing real social problems. The examples span over one hundred years: W.E.B DuBois conducted hundreds of house-to-house personal interviews in the Philadelphia Negro, published in 1899; in the action research movement of Kurt Lewin in the 1940s and the circle of planning, action, and fact-finding about the result of the action; Paulo Friere’s Pedagogy of the Oppressed in 1970s, which critiqued the concept that learning comes from teachers “depositing” thoughts into their student’s heads; the disability rights activism in the 1980s and 90s that popularized the
phrase: “Nothing About Us Without Us.” At the end of the evening, the key message was clear: Researchers today must remain upfront and genuine when reaching out to communities for community-based research. The relationship between a researcher and community members should be one of trust, respect, and mutual interest, which is precisely the goal of Community Based Participatory Research, an approach to doing research that encourages collaboration between “formally trained researchers” and community members. CBPR strives for partnerships that share power, resources, credit and results. Fundamentally, this approach appreciates that each partner in the project brings knowledge and skills that have value and posits that those who have experienced injustice hold the expertise and researchers are only as useful as the community determines. The CBPR partnership then takes this collectively generated knowledge and uses it for interventions, policy and social change to improve the health and quality of life of community members.
The Impact of the Work Environment on Obesity: A Rising Dilemma By Aditya Bissoonauth, MPH ‘16 U.S. adults spend approximately 25% of their lives at work. As we know, the work environment can create excessive pressure for its employees, and this in turn can lead to changes in eating habits, sleep cycles, and behavior patterns. In addition, other factors including poor ventilation systems and excessive strains to the body due to constant heavy lifting may lead to work related injuries and illnesses. Further, employees who hold positions in office settings sit for long periods of time at a desk, with little opportunity to engage in any healthy activity. Remaining seated for an extended amount of time can lead to chronic back pain, vision implications, and most importantly, an increased risk of obesity. Studies have shown that if those who
sit at desks all day were to walk over to their co-workers to relay messages rather than relying on email or phone chats to communicate with people in the same building, they could prevent themselves from gaining an additional pound yearly. Literature from the Centers for Disease Control and Prevention (CDC) states that over one-third of adults in America are obese. (Individuals who have a measured Body Mass Index (BMI) of 25 or higher are considered overweight and those with a BMI of 30 and up are considered obese.) Obesity opens the door to additional adverse health concerns including cardiovascular disease, high blood pressure, diabetes, and certain types of cancer, liver
disease and stroke, among others. But if certain behaviors and lifestyle choices were altered, then we could more directly affect the obesity epidemic in our country. One way to begin addressing this epidemic is to focus on eliminating or decreasing risk in the work place environment. Creating awareness and providing adequate education are the first lines of defense in combating obesity. Public Health officials should be promoting acts for healthier lifestyles and promoting alternatives to high fat and high caloric foods. In the workplace, this might begin with an initiative to replace vending machines with healthier snacks such as almonds, dried fruit, or even an
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Interview with Dr. Anthony Santella, Assistant Professor, MPH Program By Eugenia Boye-Codjoe, MPH’15 How did you learn about Hofstra University, and what led you to pursue a faculty position here? For most of my public health career I worked in the New York City metro area, so I’ve always known of Hofstra as a respected university on Long Island. The MPH program began in 2012, and in 2013, while I was at the University of Sydney in Australia, looking to move back to the area, I investigated new faculty openings in New York and was impressed by the Hofstra leadership’s commitment to health and medicine, the impressive full and part-time MPH faculty, and the methods-oriented curriculum at Hofstra- so I applied for a job and here I am! Which classes are you teaching this semester? What is your favorite class to teach? I am teaching three classes this semester: MPH 200: Introduction to Public Health, COMH 208: Program Design and Implementation, and COMH280E: Community Organizing and Capacity Building. My favorite class to teach is Program Design and Implementation, because I think every public health student should have these skill sets. As I worked as the Director of Program Planning and Technical Assistance for HIV Care and Treatment Programs at the New York City Department of Health and Mental Hygiene (DOHMH), this is also the area in which I have the most experience as a professional public health practitioner. In the spring semester I will be teaching a new elective on HIV and sexual health, which is also within my area of expertise, and I’m excited to teach that class too. What do you enjoy and find most challenging about teaching? I enjoy being able to pass on the skill sets that I’ve learned and developed as a public health practitioner to new and early-career public health practitioners. What I find most challenging is that most of our students have many competing priorities in their lives: work, school, family, and other obligations. Ideally everyone would be a full-time student here all day every day, engaging with the faculty, participating in activities, and doing internships. Those supplemental activities outside of the classroom are what can make or break a student’s entry into the public health workforce. And so it’s challenging and sometimes frustrating when not everyone has the time to participate in those enrichment activities.
What were you doing prior to joining the faculty here? I finished my doctoral program in 2007. From 2008-2009 I was the Director of Program Planning and Technical Assistance for the DOHMH in their Ryan White HIV program. In late 2009 I started teaching in the MPH program of the Brooklyn campus at Long Island University. During my three years there, I also spent one day a week at the DOHMH as a Senior Program Planning Consultant. In mid-2012 I moved to Sydney, Australia and for the last two years before coming to Hofstra I was a faculty member in the Master of HIV, STIs and Sexual Health Program at the University of Sydney Medical School. What are your research interests? Can you briefly describe your work in these areas? My research agenda focuses on expanding rapid HIV testing into nontraditional settings such as dentistry, community, pharmacy and health promotion settings. Most of my work is related to dentistry and dental professionals, so I do a lot of work with dental hygienists in the United States. My work in other countries, including China, India, Vietnam and Australia has been with dentists because in most of those countries there are no dental assistants or hygienists the dentists are responsible for all aspects of patient care. I explore the providers’ knowledge of HIV, their attitudes towards people living with HIV, their willingness to do rapid HIV testing in their setting, and patient acceptability of the rapid test being offered. I already find my research rewarding; we are making slow but steady progress in terms of potentially changing policy around where testing can be offered, how it’s paid for and who can do it. Once our research has health policy implications then it’ll be even more rewarding. What are your early impressions of life at Hofstra and in the Long Island area? I’m new to both Hofstra and Long Island. Before I moved to Australia I lived in Manhattan for six years and really only came to Long Island a few times to go to the beach. Now I live here in Nassau County not too far from the university, but I think Nassau County has a lot going for it. We have a little bit of everything in terms of health care, education, culture, parks, and beaches. Really you can find everything that you need within the boundaries of the county. And if you need a little more exposure to the outside world,
you’re just a quick train ride away to New York City. I must say, however, as someone who has always lived in big cities, I’m still getting used to suburban life. But the Hofstra community has been warm and welcoming. I’ve now been here a little over 2 months and have felt very welcomed by my colleagues and students. The university has made an impressive commitment to the public health field and Hofstra’s MPH program by reconfiguring programs within the relatively new School of Health Sciences and Human Services, by building and opening a new medical school, and later this year, opening a new School of Nursing. There is clearly commitment from the Hofstra and North Shore LIJ Health System leadership to public health education, and I think it’s an exciting time to be in the health professions at Hofstra. Tell us about some of your other interests and what you like to do in your free time. In my free time I travel quite a lot, both professionally and personally and I’m fortunate that my faculty position affords me the flexibility to travel. In fact, I just mailed out my passport this morning to get new pages added to it because I only had one page left. I also play tennis, go hiking quite a bit, and spend a lot of time with my dog, Tillie--she’s my sidekick. I spend a lot of time with my family as well. I grew up about an hour away from here and most of my family still lives in the same area in Connecticut, so I spend a lot of time with them. I also have 4 and 6-year old nieces who I see regularly. What do you consider to be one of your greatest achievements? Why? My greatest professional achievement has been earning two graduate degrees: a Master of Public Health degree from Emory University and a Doctor of Public Health degree from Tulane University. My parents always placed great emphasis on the value of education, and this was coming from two people who really didn’t have the opportunity to be educated. My father only completed middle school, and my mother went to high school here in the United States and earned a GED while I was in high school. They both moved here from Italy when they married and so my brother, sister and I were the first generation born in the United States. We have all done well for ourselves in our own ways, which is all one can ask for.
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Interview with Dr. Anthony Santella, Assistant Professor, MPH Program By Eugenia Boye-Codjoe, MPH’15 What motivates you to do your best? I’m very motivated professionally by seeing the impact of my work. I am extremely passionate about the work I do in HIV prevention and with people living with the disease. HIV is a very complicated disease, unlike many other public health problems, because there is a lot of stigma and discrimination attached to the disease and the myths abound. To complicate that, we have a lot of people living in this country and other countries that are infected with HIV and are unaware of their infection, so they are unknowingly spreading the virus. The reason why I focus my efforts on expanding HIV testing is because if HIV testing could be a normal, routine part of health screenings and all providers worked toward achieving the CDC’s goal of having everyone between the ages of 15-65 know their HIV status, we would be making better strides toward having an AIDS-free generation. When did you realize your passion for HIV screening research? My undergraduate degree is in biology. When I finished college I worked in the pharmaceutical industry for a couple of years and made very good money, travelled around the US going to conferences and all of my friends were jealous of me--but I hated the work. I thought it was boring and saw that everyone was relying on physicians who knew nothing about public health to make important decisions. So I switched careers, moved into public health and decided to go back to school to get my MPH. At my MPH orientation,
faculty members were presenting opportunities for research assistants. My first research assistantship that I held was in an HIV vaccine clinical trial that was being done at Emory University Hospital. My job was to recruit men who were at high-risk for HIV into this preventive vaccine trial. Observing people’s interactions, learning why people were engaging in high-risk behavior, what motivated them to be in a clinical trial, and what motivated them to tell their friends about it really got me interested in health behavior and health policy. I found HIV to be an interesting disease because of the social and behavioral aspects and so it became something I wanted to concentrate on. I stayed with the internship throughout my MPH program and when I did my doctoral program I focused my dissertation on people living with HIV and their health and economic outcomes. Hence,, one research assistantship has directed my career! If you could choose a course that you have always wanted to teach, what would it be and how would you teach it? The course I’d be most interested in teaching, because it’s what my professional career has focused on, would be about HIV, other sexually transmitted diseases and sexual health. And excitingly, this is the newest elective that we’ll be offering in the spring semester. It’s a three credit elective course open to all health profession students, and the class will focus on the life cycle of HIV: from the biology of HIV and other STIs, important clinical aspects that public health professionals need to know about and understand, the epidemiology of HIV and other STIs both in this country and globally, preventive technologies like condoms, microbicide gels and vaccines and the roles they play in preventing HIV, and, a large part of the class will focus on evidence-based strategies for specific vulnerable populations including men who have sex with men, young people, injection
The Impact of the Work Environment on Obesity: A Rising Dilemma assortment of vegetables, which can slowly curb the appetite of hungry employee. If employees were exposed to healthier foods in vending machines over and over again, they might eventually accept healthful eating as a normal way of life. It’s well documented that continual stress from a job or workplace can lead to what is known as “stress eating” or “emotional eating,” which usually involves the consumption of unhealthy foods. Implementing stress management programs is another vital component in teaching people how to cope with stress in the workplace.
In October of 2011, the CDC implemented the National Healthy Worksite Program (NWHP) for all employers across the United States, with the goal of adopting workplace health improvement programs. These programs identify and educate employees on obesity, excessive weight, and other chronic conditions related to the unhealthy aspects of office jobs. The NWHP accounts for evidence-based health plans that give workers the opportunity to engage in health coaching, workshops and seminars. It may also provide for time at work, which may
drug users and sex workers. At the end of the course, we’ll look at the role that both behavioral and biomedical research has in controlling the HIV epidemic. The class covers a little of everything and is very much case study based. We’ll have individuals who identify with those high-risk populations come into the class to speak about their experiences, as well as government and non-profit organizations that serve those populations come to speak. It will be very hands-on learning. I encourage everyone to take it. What is your philosophy on teaching and learning? I strive to adhere to principals of adult learning, meaning the adult student contributes to the learning process just as much as I do as the instructor. A student’s life and work experiences should contribute to class discussions. Some people work within the health system and some don’t, but we have all had interactions with health systems so everyone has some experience to bring to the table. I very much rely on a public health practice oriented approach, like we have here at Hofstra--where there is dialogue and interaction between faculty and students, not just the professor regurgitating facts that students should memorize. I’m also a big proponent of servicebased learning, so in many--if not all of my classes, students will interact with the community in which we learn. For example, in my program-planning course this semester students are assigned in small groups to a community organization; from non-profits like Planned Parenthood to the Diabetes Education Program at North Shore-LIJ, students study and develop a program plan for that agency. I think it’s crucial that we produce graduates who can hit the ground running and have skill sets that they can contribute to the field, as opposed to offering them an education in which everything is theoretically focused and they learn only about calculations and theories without knowing how to apply them. continued from page 3
be devoted to physical activity such as structured exercise or walking. Overall, the NWHP empowers both employers and employees to strive for healthier outcomes with additional initiatives and does its part to fight the obesity epidemic in the workplace. With the amount of time that office workers spend at their jobs--and at their desks--they are bound to develop new social and health behaviors, and often, these behaviors are harmful. So why not learn to practice healthy workplace behaviors for better overall public health? Lets walk around the office and talk about it.
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Effects of Geography on Health: HIV in Africa By Shaanan Meyerstein, MD, MPH ’13, Emergency Medicine Specialist, Children’s National Health System, Washington, DC Working in Africa for a year as a pediatric HIV clinician comes with a variety of challenges. Botswana, a southern African country in the Kalahari Desert, has one of the highest HIV rates in the world, and while living there, I was stunned to discover the extent to which geography and environment complicate the provision of healthcare on a daily basis. During my time at the HIV clinic in the capital city of Gaborone, announcements were often made to inform the public of the shortages of very commonly used antiretroviral medications that the patients relied upon. Furthermore, the clinic experienced constant delivery problems from production sites in Europe as well as other locations because of the tremendous distance required to travel to Botswana from other parts of the globe. Similarly, the country’s main public
hospital, where I admitted sick children and which was located adjacent to my clinic, would experience water cuts multiple times a week because of a colossal drought drying up the country’s main reservoir due to climate and weather extremes. Furthermore, electricity blackouts became a regular occurrence at the health facilities despite the fact that the facilities often had generators. Imagine not being able to wash one’s hands or use restrooms with running water at a hospital. Imagine how a blackout affects a patient who is reliant on a ventilator or a doctor performing surgery. As part of my job, I would fly every Tuesday on a 6-seater propeller plane to a small district hospital in the middle of the Kalahari Desert to help with the medical management of some of the very complex pediatric HIV cases present there. Unfortunately, because
of their remote location and distance from the capital city, most of my patients who required surgical care or subspecialty care were unable to receive it. No physicians wanted to move their families to these remote areas to practice. Moreover, even reaching this district hospital was a challenge for many of the patients, who were already walking miles just for a routine appointment. Access to prescribed medications also added to the challenge because most required refrigeration, which wasn’t always possible. After working for just a short period time in Botswana, and dealing with countless medical challenges while there, I realized the importance of understanding the impact one’s geography has on providing effective healthcare management.
Bringing a Public Health Message to VOICE Day By Saeyoan Thiru, MPH ’15 On Friday October 3, 2014, Hofstra University’s Society of Public Health Advocates (SOPHA) participated in VOICE Day 2014, an event sponsored and organized by the Rehabilitation Counseling program of Hofstra University to raise awareness, encourage advocacy, and provide an educational environment for the exchange of ideas and support services for individuals with disabilities across the lifespan. VOICE Day encourages the public to interact with various presenters including rehabilitation specialists, counselors, students, health agencies and government agencies to access, learn and explore the many resources available to them in Nassau County and help improve their quality of life. VOICE Day exemplifies the power of community partnerships to promote public awareness and highlight issues of advocacy, accessibility, education and employment for people living with disabilities and chronic illnesses. SOPHA’s main purpose during VOICE Day was to educate the public on key statistics that
can be used to help determine their health status. In our society, we rely heavily on physicians, medical services or other medical professionals to inform us of our health status. However, on VOICE Day, SOPHA aimed to educate and encourage community members to rely on their own ability to determine if they are healthy or not, by helping them understand how to determine and interpret their blood pressure, cholesterol level, body mass index and glucose level, as well as determine the appropriate amount of rest, exercise, and food servings one needs to maintain a healthy life. SOPHA encouraged those who attended to become active members in utilizing primary prevention and encouraged selfreliance in improving their health. SOPHA also educated the public about the endless possible career opportunities in the public health field, as these are the jobs that are essential to keeping our communities safe and healthy, and these are the professionals who work to help
save money, improve quality of life, help children thrive and reduce human suffering. Since VOICE Day was an event tailored to individuals with disabilities, SOPHA informed the public of various national public health practice and resource center programs and New York State-based programs offered to those with disabilities or long-term chronic illnesses to help improve their quality of life. SOPHA was honored to participate in VOICE Day. The event encouraged and educated the public to take a stand, utilize primary preventions and take action to control and improve their own health status as well as the health status of others.
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Containing the Dengue Epidemic in South Asia By Akshat Jain, MD, MPH ’15, Department of Pediatrics, Hofstra North Shore-LIJ School of Medicine, Fellow, Hematology/Oncology and Stem Cell Transplantation, Steven and Alexandra Cohen Children’s Medical Center of New York Managing international global health poses unique challenges. In my work within the South Asian region, a multiplicity of issues makes delivery of public health policies difficult. It is a delicate task to create and implement a public health program without running into many obstacles. Further, there is no way to anticipate these obstacles, and so every public health worker should be ready to deal with unexpected challenges. On a recent trip to India, health care leaders asked that I intervene in the efforts to contain the Dengue epidemic, which required significant pediatric hematology and public health planning. Dengue is a mosquito-borne illness transmitted from one infected human to another via the mosquito vector, Aedes aegypti. Dengue has high prevalence in tropical areas, especially during transitioning weather. Asia is one such
Creating awareness on Dengue and Fluorosis on Indian television (author, center bottom)
area, and records several thousand deaths every year from the viral hemorrhagic fever caused by unmanaged Dengue viral infection. Patients usually die of bleeding from every orifice and blood that collects in the abdomen, lungs and brain--if the fever is not managed in time. In an effort to successful contain the spread of Dengue fever in South Asia, my team proposed a number of ultimatelyeffective measures, beginning with an institution of the “one house one drain” rule for the neighborhoods that were most affected by the epidemic. This rule stipulates that members of every house in the affected area be assigned the duty of
Leading by example and managing infected patients in rural areas (author, right)
cleaning out stagnant water they’ve collected. (Stagnant water is known to be a breeding ground for mosquitoes.) Within each household, we also instructed that all water cooling devices, open drains and sewers be either covered or cleaned out. We succeeded in clearly alerting the public of the “one house one drain” campaign and we repeatedly encouraged everyone to act on it. We achieved this without bombarding people with multiple initiatives, which often only serves to distract from the pressing task at hand. Next, we stored additional platelet units in the blood bank. At the inception of this plan, a blood donation drive was initiated that succeeded in collecting multiple units to be ready in the event that the hemorrhagic fever epidemic hit. Another highly effective measure was to choose a catch phrase, loosely translated in English as “prevention avoids death.” We organized a print and AV media campaign to enlighten the medical fraternity and public alike regarding the fatality of this disease. Our initiatives also included a measure to alert medication prescribers of the dangers associated with administering ibuprofen for pain and fever in Dengue-infected patients. Ibuprofen enhances platelet destruction and pushes a patient suffering from the fever towards death. Instead, we transmitted a clear message to healthcare workers that
treatment must involve early rehydration and the use of Paracetamol for fever. Further, when we interacted with medical workers on the ground, our focus was on management, not lecturing about the pathogenesis of the disease. This interaction was not only effective, but also it also allowed our team to preserve the pride of the practitioners and kept everyone on point. Despite our success, there were a number of unforeseen challenges during this time. One challenge in particular became apparent during our “clean up” drive. When we walked into neighborhoods with brooms in our hands, the locals confronted us. We discussed with the locals the hazards posed by having open sewers and water meant for commercial construction sites filling water tanks because the sources weren’t closed off. In addition to resistance from local residents, we also faced resistance from corporate think tanks that refused to accept the need of such interventions, and who argued that the situation was under control. Ultimately, however, in addition to the measures explored above, by including the local healthcare leaders and initiating the public-private model at the outset of our endeavors, we were able to receive aid from the Ministry of Health to pass orders for immediate clean-outs which boosted the entire effort.
Alerting the local medical fraternity (author, front of room)
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The Killer in the Shadows: Have we forgotten infectious disease? By Khadija Auguste, MPH ‘15 and Jody-Ann MPH ‘15 Over the years there have been dramatic shifts in leading causes of death around the world and in the United States. In the 1900s the leading causes of death in the US were infectious diseases (e.g., Influenza, Pneumonia and Tuberculosis). But as time progressed and technological advances were made in medicine and public health practices, infectious diseases that were once considered leading causes of death soon became controlled and relatively obsolete. Currently, when healthcare professionals consider leading causes of death, they focus on chronic health and its relationship with social determinants, access to health care, quality of care and cost. Practitioners and public health professionals work tirelessly to decrease the mortality rates for diseases such as cancer, diabetes, and obesity. But with this shift in focus, have we begun to take for granted the importance of safety, health promotion, research and involvement in curbing the
spread of certain infectious diseases? The Enterovirus D68 (EV-D68) was first discovered in 1962 in California and can cause mild to severe respiratory illness. According to the CDC, Enterovirus D68 is one of 100 non-polio enteroviruses and may cause fever, runny nose, sneezing, cough and body aches, which can then lead to more severe symptoms including wheezing and difficulty breathing. Enterovirus infections aren’t usually considered diseases that require notification to and tracking by departments of health. However EV-D68, seemingly controlled since its discovery, wreaked havoc on our nation’s children in 2014. Since the emergence of the virus in mid-August, there have been 973 confirmed cases and 8 associated deaths in the United
States. Although enteroviruses are common and do affect children every year, EV-D68--an isolate of the more common enteroviruses-is the habitual cause of severe illnesses in children, specifically children with asthma. Everyone is at risk for Enterovirus D68, including adults who may exhibit mild symptoms or no symptoms, infants with weak and developing immune systems, and teenagers with asthma. In 2014, the morbidity of EV-D68 increased throughout 47 states in the U.S. According to epidemiologists from the CDC, the most severe cases occurred in Illinois and Missouri; other serious cases occurred in Alabama, Colorado, Indiana, Iowa, Kansas, Louisiana, New York and Montana. While it is believed that EV-D68 originated in Central America and some have theorized that the rise in EV-D68 is due to the number of immigrant children from Central America currently living in the U.S., a more likely explanation for the spread of the virus in the states mentioned above is that the aforementioned states also have higher rates of asthma cases. EV-D68 is most prevalent in the fall season. It spreads through coughing, sneezing, and coming into contact with infected surfaces. According to the CDC, there is no specific treatment for EV-D68 respiratory-related illnesses. And currently, there are no antiviral medications available for EV-D68. As the virus is easy to contract, we must ask ourselves whether we do an adequate job of promoting awareness amongst the population, and in particular, with children and teenagers. Perhaps there should be mandatory educational programs in our schools that focus on the prevention of virus spread. However, this in itself cannot be the only initiative. Continual research is crucial in the field of infectious diseases in general. Despite the holes that exist in our current bank of health care initiatives as they relate to
infectious disease however, public health professionals should also be commended on their response to recent outbreaks and their current efforts to promote awareness. In fact, since the rise in EV-D68 cases, CDC experts, practitioners and several public health organizations have been working tirelessly to decrease contraction rate. The CDC has developed a faster laboratory test for detecting EV-D68 and has also received reports that numerous states are beginning to see a decrease in infections. As mentioned earlier, there are currently 8 confirmed deaths associated with EV-D68. And with Ebola claiming the life of one individual so far in the U.S. and thousands of lives in West Africa, the question remains, “Did we forget about infectious diseases?” Ebola, similar to EV-D68, emerged decades ago. These are not new diseases. And so, as Ebola and EV-D68 become headliners in today’s news, public health advocates and professionals must continue to support policies, training, research and education related to EV-D68 and those viruses that were once forgotten, but have now returned, virulent as ever.
Sources: http://vir.sgmjournals.org/content/85/9/2577.long http:// www.cnn.com/2014/10/11/health/michigan-enterovirus-68-death/ http://www.snopes.com/politics/immigration/enterovirus.asp http://www.decodedscience.com/hev-68/43151 http:// www.cnn.com/2014/09/08/health/enterovirus-d68-symptoms/ http://www.medscape.com/viewarticle/751032 http:// www.cdc.gov/non-polio-enterovirus/about/ev-d68.html http:// www.webmd.com/cold-and-flu/news/20140909/enterovirus-d68parents http://jama.jamanetwork.com/article.aspx? articleid=1910108
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The American Public Health Association’s 142nd Annual Meeting By Pascale Frederique, MPH ‘16 Thirteen thousand. That’s how many attendees were present at the American Public Health Association’s annual meeting held in New Orleans, Louisiana this year. Just imagine-that’s the equivalent of a medium-sized town descending upon New Orleans for four days! This year’s meeting was truly an awe-inspiring, invigorating, and insightful experience. The vibrant population of conference attendees consisted of recent graduates, job seekers, doctors and researchers--all professionals and leaders in the public health field. I had never been to a large professional gathering like this and it was exciting to be surrounded by ideas, conversation, thirst and passion for three busy days. Conference organizers scheduled the days so that each followed the same basic pattern: sessions and lectures were divided between 1.5 - hour time slots, beginning at 6:00 a.m. and running throughout the day until the final sessions at 9:00 p.m. Every public health topic imaginable was covered at the
sessions, ranging from maternal health and biological and chemical weapons to programming and applied statistic workshops. Thanks to the multitude of lecture sessions available, it was crucial for all attendees to build an itinerary around a particular interest. Attending the APHA national meeting offers participants an immersion into the public health professional field. I heard the fluid exchange of ideas, the critiques of certain health practices discussed and debated, and I watched as relationships were forged over common interests. Every morning brought an energetic buzz as conference attendees anticipated the events of the day and each evening ended with social activities—social groups headed out to try a new Creole dish while discussing the days’ happenings. I hope all MPH students have the chance to experience the APHA’s national meeting at some point during their education at Hofstra-this event can be career--and life-changing. Next year, APHA will meet in Chica-
go; although the APHA crowd can bring a lot of energy, the windy city bites back during the winter. So bundle up and see you in Chi-
Hofstra’s MPH Information Table at the Expo
Hofstra MPH students at APHA in New Orleans
Ethics Exchange By Isma Chaudhry, MD, MPH ’15 and Pam Lefkowicz, JD, MPH ‘15 “Prejudice is a burden that confuses the past, threatens the future and renders the present inaccessible.” Maya Angelou For our first installment of Ethics Exchange, a column that will explore challenging ethical questions, we will focus on issues of ethics and racism. Our discussion begins with a review of the Tuskegee syphilis study, which ran from 1932-1972 and was conducted in a rural, agrarian community in Macon County, Alabama. The purported purpose of this experiment was to determine the natural course of untreated, latent syphilis in black males. On the surface, the study seemed to be providing a public health service. However, one does not need to dig too deeply to reveal the prejudices that were inherent within the community of medical professionals who spearheaded the experiment; deceit and misinformation as it related to the recruitment of participants; and, long-standing negative health consequences for participants. The study was predicated on the premise that black males were sexually immoral and lustful which caused syphilis to spread in the community. Further, medical
professionals deceived the participants: they were advised that they would be receiving treatment for syphilis, when they actually would not be receiving treatment. While there were many to blame for the mistreatment of the participants, much has been written about nurse Eunice Rivers, beloved and trusted in her community, and whether she used the cloak of her authority as a health care professional to deliberately misinform the participants. Some argue that Nurse Rivers deliberately misinformed participants and that her actions were particularly egregious as she was also involved simultaneously in administering treatment to other individuals who were not part of the study. Rivers defended her role in the study however, by arguing that the participants in the Tuskegee study had more access to medical care during their participation than they would have had otherwise, had they not been involved. Some might argue that the mistreatment of this population of American males at this particular moment in American history is upsetting but not surprising. The 13th Amendment--adopted late in 1865--
officially abolished slavery, but the status of the freed slaves in the post-war South remained precarious and significant challenges remained. The 14th Amendment (adopted in 1868) gave former slaves the rights of citizenship and the equal protection afforded by the Constitution, but in practice, it was difficult for former slaves to participate socially and economically on a truly equal level. Former slaves gained the right to vote in 1870 with the passage of the 15th Amendment and in1896, the U.S. Supreme Court decided the case of Plessy v. Ferguson, which legalized racial segregation under the “separate but equal law.” Ultimately, it was not until the civil rights movement of the 1960s that blacks made significant political and social gains. The U.S. Supreme Court overturned Plessy v. Ferguson in its 1954 decision of Brown v. Board of Education which outlawed the “separate but equal” doctrine and held the notion that separate education facilities are inherently unequal, ultimately paving the way for integration.
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SOPHA’s CORNER
The society of Public Health Advocates (SOPHA) is a Public/Community Health graduate student-run organization at Hofstra University. SOPHA aims to encourage environmental awareness, disease prevention and health promotion
through advocacy both at Hofstra and in the surrounding communities. The purpose of the organization is to collaborate amongst the MSCH and MPH program in the promotion of public health on and off campus. SOPHA strives to bring awareness to social determinants of health to minimize health disparities
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Ethics Exchange The legacy of the Tuskegee study is that it showed the black community that the medical establishment did not respect it members as equal human beings, deserving of the truth and of proper medical care. Further, he study had a ripple effect that can still be felt today. Studies have shown hat to this day, there are lower immunization rates among the African American population and a reluctance to seek treatment. Even if the stated goal of the African American physicians who participated in the
through community outreach and engagement. To learn more or join, visit: sopha@hofstra.edu, facebook.com/SOPHA, and on Instagram @HofstraSOPHA.
Tuskegee study was to secure additional funding for promoting health in the black communities of rural America and earn respect amongst Caucasian physician, the manner in which the study was conducted erased any potential good and caused irreversible harm. There should be proactive and rigorous evidence-based research to address health care disparities. Ethnic minorities are more likely to subscribe to lowerend health plans, which can factor into health care discrimination. In particular,
research studies have observed racial disparities in the delivery of diagnostics and treatments for heart disease, HIV, asthma, breast cancer, and pain management. Moving forward, health care professionals must be cognizant of prejudices and strive to treat all people with dignity and respect. The Tuskegee study is not ancient history –it ended just 2 years ago. We must not repeat the mistakes of the past—the health of our population depends on it.
Fed UP Fed Up is an eye-opening documentary that highlights the miseducation of the American Public in the areas of food and fitness. For 30 years, the American public have overlooked the undeniable link between sugar intake and obesity and therefore, sugar consumption has been largely unchecked. This documentary also explores how ‘calories in, calories out’ mantra touted by nutritionist, policy makers and even doctors have misled Americans and how food industry lobbyists have found this model to retain provide by lowering calories in food products while pumping sugar into foods as a replacement. Although people live by the ‘calories in calories out’ model,
levels of obesity and diabetes are skyrocketing and a generation, of children are growing up fatter than their parents. Fed Up argues that if the lobbying power of ‘Big Sugar’ remains strong than policies addressing this major (and majorly expensive) issue will never pass. Fed Up exposes how sugar lobbyist who use their limitless financial resources to silence the concerns of States, schools, Congress and the average American are ignoring the relationship between high sugar diets and poor health. SOPHA hosted a viewing of this film on October 16th, 2014 and left attendees feeling FED UP and empowered to find solutions. 10
Stomping Out Domestic Violence On a windy and unseasonably cold Sunday morning, resident of Nassau County and advocates against intimate partner abuse gathered for the Third Annual Domestic Harmony Walkathon to Stomp Out Domestics Violence. The event took place on Sunday, October 26, 2014 in Eisenhower Park. Community members as well as members from the Domestics Harmony Foundation, and related sponsors gathered for a short welcoming ceremony and sponsors provided brief sentiments and words of encouragement for those who came to
walk. All in attendance were reminded that silence perpetuates violence and were urged to stand for those who could not. After a brief ceremony, walkers gathered and marched for approximately two miles around the park. If your or someone you know is a victim of intimate partner abuse or domestic violence, service are available. Contact the Domestic Harmony Foundation of the Safe Center of Long Island for more information. HELPLINE: (516) 385-8292, or info@dhfny.org.
MPH Photo Recap
Student Editorial Committee Abdul Moiz Qadri, MPH ‘16 (Chair); Saeyoan Thiru, MPH ‘15 and Kemar Trowers, MPH ‘16 Bridge Newsletter Layout and Production Saeyoan Thiru, MPH ‘15 MPH Photographer Thalia Stewart, MSCH ‘15 For More Information; To learn more about Hofstra’s MPH and MS in Community Health Programs and to find out about upcoming events and view archived webinars, please visit www.hofstra.edu/publichealth . You can also email Corinne Kyriacou, PhD, MPH, associate professor and director, MPH and MS in Community Health programs, at corinne.m.kyriacou@hofstra.edu. 11