DGHI Funds 21 students for Fieldwork Projects Beginning Summer 2008

DGHI Grant Recipients and Projects

Petrina Craine
• Junior Biology Major & GHC
• Project Title:  “What’s Bugging Me?” The Prevalence of Helminth Infections in School-Aged Children of Lomé, Togo
• Project Site:  Lomé, Togo
• Abstract:  I plan to travel this summer to Jijolé, a neighborhood outside of Lomé, Togo, in order to conduct an analysis of infection incidences and prevalence rates of parasitic infections, specifically helminths (worms), among school-aged children. I would also observe any correlates of co-infection with diseases such as HIV/AIDS or malaria. The analysis would be conducted in the form of a survey questionnaire, which would serve as a tool used to assess behaviors associated with a child’s risk and likelihood of being infected. The purpose of this research is to help develop and facilitate a curriculum, specific to the community that would be taught to the children. The health promotion curriculum would communicate prevention efforts for the children to implement in their daily lives.

Brittany Hesbrook
• Sophomore PoliSci, ICS and GHC
• Project Title:  Nutrition and Disease
• Project Site:  Khayelitsha, South Africa
• Abstract:  The overall goal of the project is to link the nutritional status of people in the Khayelitsha Township to common chronic conditions such as hypertension, diabetes, and asthma.  The impact of urbanization on unhealthy lifestyle behaviors such as an unhealthy diet, tobacco use, lack of exercise, and stress will be researched into relation to risk factors for chronic disease.  The way this research will be carried out will be through developing and administering questionnaires, and basic statistical measures such as blood pressure and weight.
Personally, the project will be modified to look specifically at the birth weight of children and the impact that can have on their development of risk factors for chronic disease.  Factors that effect low birth weight such an improper nutrition and smoking will be researched and viewed within the context of urbanization and a low income area.

Tamara Louie
• Freshman intending BME major
• Project Title:  Equipment assessment, repair, and manual writing in Kampala
• Project Site:  New Mulago Hospital in Kampala, Uganda
• Abstract:  A team of neurosurgeons and various other specializing doctors, as well as engineers and project coordinators, are travelling to the New Mulago Hospital in Kampala, Uganda, to temporarily assist the hospital as well as reviewing the medical equipment at the hospital and fixing or improving the equipment.  For the students involved, the project needs include setting-up, testing and troubleshooting new and old donated equipment (e.g., ventilators, anesthesia monitors, operating microscopes, transport heart monitors, etc) and assisting with repairs.  The students will also assess how hospital staff use current equipment and documenting needs and develop simple step-by-step operational manuals.  The students will also gain medical experience as they shadow the neurosurgical team, observe procedures, and see application of equipment from repair to actual use.  The projects may start at Duke with small equipment testing and repair and conclude with the equipment being delivered and repaired at Mulago Hospital in Uganda.

Jessica Green
• Freshman intending Pubpol major w/ Education Certificate
• Project Title: ZOE Ministry “Giving Hope”
• Project Site:  Rwanda
• Abstract:  The Giving Hope Empowerment Methodology is to protect the rights of and provide support to orphans and vulnerable children affected by HIV/AIDS so that they may be empowered to manage their own well being and the stability of their families, to participate in the social and economic development of their communities, and to live in the shelter of hope.  The data collection takes place through follow-up interviews of a sample of the 4,000 orphan-headed households and 14,000 orphans in the various districts in Rwanda.  To achieve the empowerment goal of self-sustainability in 2-3 years, a few of the current elements include: training in heath and hygiene, HIV/AIDS Awareness and Training, training in child rights, youth clubs, food security, school reintegration, community reintegration, and vocational training. 

Maddie Pongor
• Freshman intended Pubpol major, Spanish minor, Policy Journalism and Media Studies Certificate
• Project Title:  ZOE ministry “Giving Hope” assessment
• Project Site:  Rwanda
• Abstract:  The Giving Hope Empowerment Methodology is to protect the rights of and provide support to orphans and vulnerable children affected by HIV/AIDS so that they may be empowered to manage their own well being and the stability of their families, to participate in the social and economic development of their communities, and to live in the shelter of hope.  The data collection takes place through follow-up interviews of a sample of the 4,000 orphan-headed households and 14,000 orphans in the various districts in Rwanda.  To achieve the empowerment goal of self-sustainability in 2-3 years, a few of the current elements include: training in heath and hygiene, HIV/AIDS Awareness and Training, training in child rights, youth clubs, food security, school reintegration, community reintegration, and vocational training. 

Alanna Teng
• Junior Bio & History majors
• Project Title:  Assessing the impact of health education on knowledge and attitudes in Naama, Uganda
• Project Site:  Naama, Uganda
• Abstract:  The long-term objective of the project is to help Naama residents prevent, control, and possibly eventually eliminate the most critical diseases in Naama through health and hygiene education programs, which would allow members of the community to become more knowledgeable and aware of the communicable disease in the village. Furthermore, the project aims to create a base of information through which interventions targeting behavior can be studied and made more effective. The three parts of my project include a pre-intervention community health and needs assessment, done in collaboration with other team members and local community partners, development of a health education program, and a post-intervention evaluation of post-education knowledge and attitudes.

John Stokes
• Sophomore Psych major, Hindi minor
• Project Title:  Depression and self-esteem levels within transgender populations in India.
• Project Site:  Delhi, India
• Abstract:  The Sahara House Transgender Research Project aims to evaluate and improve depression and self-esteem levels within the transgender, or “hijra”, population of New Delhi, India. The levels are currently thought highly unhealthy and result from community stigma and the inability to find employment in sectors other than the sex trade. This project is a continuation of research begun last summer at the same location with the same subject pool. The projected time span for the research is estimated to be from May 14th until July 2nd of the current year, such that 8 full weeks will be devoted to mental health assessment and possible intervention. Lodging, meals, and transportation will be coordinated with the help of Sahara House workers, as they were last year.

GRADUATE STUDENTS

DGHI Graduate and Medical Student Grant Recipients and Projects (2008-2009)

Janeil Belle
• 2nd year Med student Undergrad- Duke B.S. Biology & A.B. English w/ Chemistry Minor. 3rd year project (9 months on site)
Project Title: Global Access to Surgical Healthcare: promoting academic and clinical collaboration in rural/urban India
• Project Site:  Districts of Gadchiroli and Pune, India
• Abstract:  This project is a comparative descriptive study seeking to characterize educational and material support, and surgical outcomes at two rural and university-affiliated, urban hospitals serving Districts of Gadchiroli and Pune, India in order to identify barriers to optimal surgical care that may benefit from rural-urban clinical and academic collaboration. Differences in surgical infrastructure and professional support are expected to be observed, reflected in measures of surgical case load and complexity, referral rates, and operative outcomes, and illustrate a divide in quality of surgical care provided by the rural and urban institutions.

Dustin Hambright
• Med student graduating in 2010, 3rd year project (9 months on site)
• Project Title:  The impact of Singapore’s tiered healthcare system on patient care.
• Project Site:  Singapore
• Abstract:  In 2002, the Singapore government spent 1.3% of its GDP on healthcare while the United States devoted 14.6% of its GDP to healthcare expenditures.  That same year, health indicators such as infant mortality rates and average life expectancy were more favorable in Singapore than they were in the US [7].  Singapore’s success at developing a unique stable health system is both exemplary and intriguing. A key component of Singapore’s system relies on the unique concept of “class wards” within all public hospitals.  This system stratifies different hospital wards based on the amount of comfort and provided amenities. The highest-level wards are unsubsidized and the lowest grade wards are 80% government subsidized. Moreover, the Singapore government has consistently emphasized that quality of medical care does not differ among these class wards. The proposed research project has three objectives.  First, it aims to examine the impact of Singapore’s class ward system on patient care and treatment outcomes in the Singapore Health Services (SingHealth) public hospital system.  Second, it will assess public opinion of the class ward system and evaluate if this opinion is representative of current patient care in the class ward system.  Lastly, the study combines the findings of the first two objectives to assess whether or not the public health care system in Singapore is successful in its own right, and consequently whether or not this should serve as a model for others to examine and implement.

Sarah Lofgren
• Med student 2010, 3rd year project (9 months on site)
• Project Title:  Field studies of a dry blood spot nucleic amplification method for infant HIV diagnosis and for HIV-1 RNA concentration determination in Tanzania
• Project Site:  Moshi, Tanzania
• Abstract:  The goal of this project is to investigate the performance of dried blood spots as an alternative to liquid plasma samples for infant HIV diagnosis and in the monitoring of antiretroviral therapy (ART) under field conditions in Tanzania. This is a field study in two parts. Specifically, we will investigate the performance of dried blood spot samples for HIV diagnosis of HIV-exposed children under 18 months of age and HIV-1 RNA quantitation (‘viral load’) monitoring of HIV-infected patients receiving ART at two rural and remote hospitals in northern Tanzania. In the first part of the study, serum will be taken from infants and part of those samples will be saved as dried blood spots and sent by regular mail to Moshi for testing. The other samples from the first part of the study will be put on ice and frozen as serum for comparison with the dry blood spots. In part two samples will be saved as dried blood spots and mailed and then frozen as plasma in the same way as the first part. But in this section of the study more blood spots will be prepared and some of them will be stored and tested at intervals of 4,8,12, and 28 weeks. In both parts of the study all of the samples will be analyzed and compared to the frozen serum as gold standard using statistical methods. If dry blood spot samples perform as well as the gold standard liquid plasma samples for viral load testing, access to viral load testing could be extended to rural and remote healthcare facilities in Tanzania.

Olukemi Ogundipe
• Med/MPH student 2010, 3rd year project (8 weeks on site)
• Project Title:  Spatial Variations in Malnutrition, and Impact of Sainte Antoine School Feeding Program on the Nutritional Status of Children in the Fondwa Mountain Community
• Project Site:  Fondwa, Haiti
• Abstract:  Fondwa is a rural community in the southwest of Haiti where Family Health Ministries has partnered with the Peasants Association of Fondwa (Asosyazan Peyizan Fondwa, APF) a local grassroots organization and a local Catholic Sisterhood to help build Saint Antoine School, sponsor a feeding program in the school and an international sponsorship program to provide school fees for individual children. The feeding program is in its eighth year of operation. This project will measure the effects of the feeding program at Saint Antoine School by measuring the nutritional status of children in kindergarten through third grade in the school and comparing them to children of the same age range in the community who do not attend Saint Antoine School. Nutritional status will be assessed by anthropometric measurements of height and weight, and hemoglobin will also be used as a marker for nutritional status. This project will also collect GPS data on all children in the study which will be used to identify any significant spatial variations in malnutrition in the community. Statistical analysis of variance and regression will be used to determine the effects of the feeding program and the GIS data will be mapped with nutritional status to identify areas of variation in the community. This project hopes to assess the success of the feeding program to date and collect data that will inform future community wide interventions.

Amy Sanchez
• Grad Student, PhD Clinical Psychology, undergrad Psych and Neuroscience (8 weeks on site)
• Project Title:  Development of culturally-specific HIV prevention for South African adolescents: The role of psychological risk factors
• Project Site:  Johannesburg, South Africa
• Abstract:  The current project explores the impact of psychological risk factors on South African adolescents’ attitudes towards and willingness to participate in an HIV prevention program. A quantitative survey will examine adolescents’ sexual risk behaviors and attitudes and will address the specific concerns associated with a history of child sexual abuse or AIDS-related bereavement. Questionnaire results and pre-existing focus group data will be analyzed and applied towards the adaptation of the Center for Disease Control’s HIV risk reduction intervention for culturally- and age-appropriate use with adolescents in South Africa, including within future biomedical approaches to HIV prevention. Future research phases will (1) examine intervention participation and completion rates among abused or bereaved adolescents; (2) investigate supplemental interventions for use with this population, and (3) extend the current research to South African preadolescents.

David Watkins
• Med student 2010, 3rd year project (9 months on site)
• Project Title: Genetic Epidemiology of Cardiomyopathy
• Project Site:  Groote Schuur Hospital, University of Cape Town; South Africa
• Abstract:  Cardiomyopathy is a disease of heart muscle that is endemic in Africa.  Various forms of cardiomyopathy – including arryhthmogenic right ventricular cardiomyopathy, peripartum cardiomyopathy, and idiopathic cardiomyopathy – are significant causes of morbidity and mortality in Africa; yet their prevalence, etiologies, and optimal treatments are poorly understood.  The aim of the present study is to compile a nationwide database of patients with these cardiomyopathies in South Africa to quantify their epidemiology more rigorously.  Special attention will be paid to the genetic risk factors of the various cardiomyopathies, since they have been reported to cluster in families.  Results of the analysis of baseline characteristics of patients in this database will eventually be used to design prospective studies to observe the natural history of cardiomyopathy in this cohort, as well as to establish an evidence base for optimal treatment.

Michelle Graziano
• Med student graduating in 2010, 3rdyear project (4 months on site)
• Project Title: Breastfeeding and undernutrition in Haitian infants.
• Project Site: Port-au-Prince, Haiti
• Abstract:  Despite recent efforts to reduce the number of individuals lacking adequate food resources, malnutrition remains a serious health concern worldwide.  Children are particularly susceptible, with undernutrition directly contributing to infection rates and more generally, childhood morbidity and mortality.  Haiti is one of many nations suffering from such effects of malnutrition.  Previous studies in the Terre Noir region of Port-au-Prince, Haiti’s capital, were conducted with the goal of identifying factors contributing to and preventing undernutrition.  However, no studies have looked exclusively at the nutritional status of infants and the likely protective effects of breastfeeding.  As a result, I, in conjunction with Dr. Walmer and Family Health Ministries, am planning to analyze the nutritional status of infants, aged birth-2 years, in this region of Haiti.  We will evaluate nutrition by measuring the height, weight and head circumference of a random sampling of infants, comparing the data obtained from these children with the WHO Child Growth Standards.  We expect infants who are breastfeeding to adhere more closely to the standard growth curves when compared to older children.  Such comparisons will allow us to identify the time at which children in this region become susceptible to the effects of undernutrition, as evidenced by stunting and/or wasting (“falling off the growth curve”).  With this information we will then be able to design and institute more timely and effective interventions, to be used locally, and potentially elsewhere.

Jennifer Nolan and Team
• Nolan: Graduate student graduating in 2009 (8 Weeks on site)
• Full Team consists of 4 Duke undergraduates, 2 Duke Graduate students (including Nolan)  and 1 UNC graduate student
• Project Title: Mental Health Project in the Kilimanjaro Region of Tanzania
• Project Site: Moshi Tanzania
Abstract: 
The primary goals of the project are to enhance our understanding of the role traditional, spiritual and religious beliefs and practices play in helping people to cope with severe mental illness and to develop a mental health education and awareness initiative in the Kilimanjaro region of Tanzania.  There are four specific aims of the project.  The first aim is to conduct in-depth qualitative interviews to explore the role that traditional, spiritual and religious beliefs and practices play in the understanding of causes and treatments of mental illness. .These interviews will be done with outpatients diagnosed with schizophrenia, with added breadth from accounts of family caregivers, mental health workers, religious/ethnic leaders and traditional healers.  The second aim is to facilitate planning and implementation of a psychoeducation intervention through training chaplains at Kilimanjaro Christian Medical Center (KCMC) to lead psychoeducation and coping skills development classes for a small group of outpatients with schizophrenia. The third aim is to assist with community mental health education and service development, through collaboration with the director of community health at the local Mawenzi government hospital and in the local community in Moshi, Tanzania.  The fourth aim is to develop a documentary on mental health for educational and training purposes from these sub-projects described above.  Documentaries will be created using audio, photo and video mediums to provide another effective means of communication and education on mental illness and health in the community.  The documentaries may be used by KCMC and Duke for education and training purposes.

Other Participants:
Whitney Woodhull (Duke class of 2010)
Tina Thomas (Duke Masters in Health Science, 2008)
Caitlin Thomas (Duke class of 2010)
Leslie Ann Modlin (Duke class of 2009)
Georgia Hoyler (Duke class of 2010)