Alex Clifford, Author at Research Blog

Picture a comic book. Maybe you think of Superman or the Hulk, all cosmic green and razzmic berry, pressed into the glossy pages of your favorite childhood graphic novel. Or maybe you think of the Sunday paper. Calvin and Hobbes inked between the op-eds and the sports column. Maybe you think of punk rock zines, or political cartoons, or Mad magazine.

Now, put your first thought aside. Walk to the Duke Medical School library and descend to the first floor. Nestled in the quiet reading room, among the serious tomes on pancreatic enzymes and brain anatomy, is a collection of comic books.

They don’t chronicle the kryptonite of superheroes or the adventures of Asterix. Instead, the curated Graphic Medicine Collection features soldiers with PTSD, mothers of children with Down Syndrome, and transgender patients’ gender-affirming care. They illustrate child loss, chronic illness, addiction, anxiety, autism, epilepsy, COVID, cancer, heart disease, reproductive health, and so on and so forth.

photo credit: @dukemedlibrary (Instagram)

In 2007, physician and cartoonist Ian Williams coined the term “graphic medicine.” He writes that the “use of the word ‘medicine’ was not meant to connote the foregrounding of doctors over other healthcare professionals or over patients or comics artists, but, rather the suggestion that use of comics might have some sort of therapeutic potential – ‘medicine’ as in the bottled panacea, rather than the profession.”

Duke’s Graphic Medicine Collection seeks to destigmatize, depicting everything from a patient’s experience with terminal cancer to STI prevention. Unsurprisingly, comics have long been used to educate and to challenge social taboos.

In 1954, they were controversial enough to trigger a congressional hearing. Despite grossing nearly $75 million in nickels and dimes (the cost of a comic in 1948), comic books fed the flames (often literally) of moral panics that came to dominate the Cold War era.

In 1949, a small town Missouri girl scout troop burned a six foot tall stack of comics at the behest of their parents, teachers, and the local priest. This event followed the publication of an article written by New York City psychiatrist Dr. Fredric Wertham which drew a correlation between the occasional vulgar language and violent imagery in comic book and increased incidence of juvenile delinquency.

Although Congress found no correlation between comics and criminal activity, ultimately disagreeing with Wertham, the comic industry created the “Comics Code Authority” out of fear of government censorship. Comics with everything from violence to werewolves, zombies, vampires and ghosts were banned. Though the comic code undeniably cowed their content, cartoonists continued to use the medium to criticize and confront stigmas.

In the 60s and 70s, for example, “subversive women cartoonists, queer cartoonists, [and] cartoonists of color” disseminated their work in political circles. Later, in 1989, cartoonist Garry Trudeau depicted the first openly gay comic character Andy Lippincott’s diagnosis with HIV/AIDS. Though some gay activists criticized Trudeau’s portrayal, his comics nonetheless challenged the public’s stereotypes, fears, and ostracization of HIV/AIDS patients and Lippincott’s impact was wide-felt and humanizing.

Garry Trudeau’s *Doonesbury* comic character Andy Lippincott is depicted here in the fictional AIDS quilt. Lippincott was later given a real panel in the quilt.

In fact, in 1990, when Trudeau illustrated Lippincott’s death due to AIDS complications, an obituary was written for the fictional character in the San Francisco Chronicle: “… Lippincott, an affable man who had attempted to cope with the devastating disease with a continual patter of gallows humor, dies quietly in his bed, the window open to a sunny day and a coveted C.D. of the Beach Boys ‘Wouldn’t It be Nice’ playing.”

American Girl’s “The Care & Keeping of You”

In the 2000s, like so many other middle school girls, when I turned 10 or 11, I was handed the American Girl’s “Care and Keeping of You.” The book includes comic strip-esque graphics and informational panels about everything from menstrual health to acne. It revolutionized the conversations that were and, more importantly, weren’t happening around girl’s health and puberty.

To put it simply: “Girls didn’t seem to have the courage to ask their own mothers these questions, but they were sending them to faceless magazine staffers in Middleton, Wisconsin.” Since its publication in 1998, “The Care & Keeping of You” has sold 7 million copies and counting.

From cancer to STIs to AIDS to puberty, comics clearly do have a place in medicine.

In recent decades, there has been a push in American healthcare for the medical humanities — a holistic movement that advocates for the intersection of science and art in medicine and medical education. Keith Wailoo, an American historian and professor at Princeton University, writes about the need for medical humanities:

“… [P]rofessional and human crisis has spawned the search for meaning and introspection about life, illness, recovery, human suffering, the care of the body and spirit, and death. Medicine’s social dilemmas, its professional controversies, human health crises, social tensions over topics from AIDS to abortion and genetics, as well as the profession’s very identity and its claim to authority have catalyzed and fed a growing demand for answers about meaning.”

Among the serious tomes included in Duke’s collection is the following spread from Tessa Brunton’s autobiographical “Notes from a Sickbed,” illustrating the onset and progression of her chronic illness. As Brunton writes, “catharsis” seems to best embody Duke’s Graphic Medicine collection. Like so many other comic strips, “Notes from a Sickbed” is a “bottled panacea.” Brunton confronts her illness and grapples with her own “search for meaning,” depicting her reality with humor, earnestness, and dialogue bubbles.

All of this to say: comics continue to have a place in medicine.

Here are a few texts in Duke’s Graphic Medicine Collection:

“Camouflage: the hidden lives of autistic women” by Dr. Sara Bargiela

“Kimiko Does Cancer” by Kimiko Tobimatsu

You can check out the entire Comic Medicine Collection here: https://mclibrary.duke.edu/about/blog/new-graphic-medicine-collection

Post by Alex Clifford, Class of 2024

Doctors Share a Vision for Ending Preventable Blindness

By Alex Clifford

On October 13, 2023

In Global Health, Medicine, Policy

Cataract surgery is often perceived as a garden-variety medical intervention akin to the colonoscopy, mammogram, or flu shot. But outside of higher-income countries, the following is not an understatement: eye care can be revolutionary.

A cataract is described as “the clouding of the lens of the eye.”

It is estimated that, globally, 36 million people are blind; that around 90% of preventable blindness cases are demarcated within low and middle income countries; and that nearly 75% of blind individuals could regain their vision with medical intervention.

Today, cataract surgery can be performed for $100 or less and, with a practiced hand, in as little as three minutes.

In that context: a blind individual can completely regain their sight in the time it takes to brush their teeth. For the price of a discounted pair of running shoes.

Dr. Geoffrey Tabin is an ophthalmologist and co-founder and chairman of the Himalayan Cataract Project. He is also the fourth person in the world to reach the tallest peak on each of the seven continents.

In late September, the Duke Global Ophthalmology Program hosted the A Vision for Ending Preventable Blindness panel to address the global scope of vision impairment, eye care interventions, and subsequent socioeconomic implications. Panelist Dr. Geoffrey Tabin, Professor of Ophthalmology and Global Medicine at Stanford University, characterized the nature of these eye conditions: “Glaucoma’s preventable, trachoma’s preventable, river blindness is preventable, vitamin A deficiency is preventable, even… diabetic changes [in vision] are preventable.” In fact, cataract surgery, in most cases, is a 100% and lasting cure.

What other health interventions boast similar statistics?

Dr. Llyod Williams holds an ice cooler which will soon contain corneas for transplantation. Photo credit: Chris Hildreth/Rooster Media

Panelist Dr. Jalikatu Mustapha, new Deputy Minister of Health of Sierra Leone, and moderator Dr. Lloyd Williams, director of Duke Global Ophthalmology Program, established a corneal transplantation program in Sierra Leone. Pictured above with a box of corneas, Williams performed the country’s first corneal transplant in 2021. Mustapha and Williams recounted a clinical experience that well-represents their objectives:

Dr. Jalikatu Mustapha is an ophthalmologist, has overseen Sierra Leone’s Eye Care programme, and lectured at the University of Sierra Lione. She is currently the Deputy Minister of Health of Sierra Leone.

While operating in Sierra Leone, Mustapha and Williams worked with a patient completely blind since her teenaged years. After 29 years and a successful corneal transplant, she regained sight in one of her eyes. Walking out of the clinic, she saw a crying young woman and asked what was wrong. When the young woman responded, the patient recognized the woman’s voice, realizing that she was, in fact, her daughter. This would mark the first time she had physically seen one of her children. Her daughter was 19.

Over the course of his career, Williams has performed thousands of eye surgeries in Africa including, of course, a number of corneal transplants.

Dr. Lloyd Williams is the director of Duke Global Ophthalmology Program and has performed thousands of cataract surgeries in Africa, Central America, and numerous other regions of the world.

Despite the obvious efficacy of eye health interventions, blindness has little priority on the global health agenda nor in low income countries where preventable cases are disproportionately located. Tabin emphasized the “travesty” of this disconnect, describing blindness as “the lowest hanging fruit in global public health.”

Why is this the case?

NGOs and governments point to the high mortality rates of infectious diseases like HIV, malaria, cholera, COVID. Blindness is not fatal, they argue, it is an apples and oranges comparison, cataracts to Ebola.

A glance at notable foundations and charities with health-related mission statements cements this sentiment. For example, among its laundry list of initiatives, the Gates Foundation funds the fight against enteric and diarrheal diseases, HIV, malaria, neglected tropical diseases, pneumonia, and tuberculosis; the Rockefeller Foundation “established the global campaign against hookworm… seeded the development of the yellow fever vaccine… supported translational research for tools ranging from penicillin to polio… spurred AIDS vaccine development;” and the Wellcome Trust financially supports infectious disease, drug-resistant infection, and Covid-19 research.

Of course, this is not an effort to undermine the impact of these institutions but merely to point out a lack of urgency to redress blindness.

The panelists challenged this “if not fatal then not urgent” thinking. Tabin cited two poignant WHO estimates: 1) vision impairment contributes to an annual $411 billion global productivity loss, and 2) the cost of providing eye care to every in-need individual would be around $25 billion.

The US Department of Defense’s proposed 2024 fiscal year budget is $842 billion. If this funding was allocated towards eye care, every case of preventable blindness could be mitigated 33 times over in one year.

The downstream effects of blindness are substantial not only for the effected individual but for their family. In the absence of sufficient eye care, children with congenital cataracts, for example, will struggle/will not attend school; they will require care, potentially removing family members from the workforce; they will struggle to find employment; and, on average, they will have a life expectancy about a third of their age- and health-matched peers. Because 90% of preventable blindness is localized in low and middle income countries, community productivity and GDP may be significantly impacted by curable conditions.

Tabin explained that “blindness really perpetuates poverty” and, on the flip side of the same coin, “poverty really accentuates the suffering of blindness.” Through his work at Stanford, Tabin identified pockets of agricultural Northern California with mass migrant workforces and high rates of preventable blindness. Documentation concerns, language barriers, and/or lack of healthcare often prevents seasonal workers and immigrants from accessing and benefiting from care, comparable to that in low and middle income countries.

Dr. Bidya Pant is an ophthalmologist and director of Geta Eye Hospital in Nepal. He has worked with HelpMeSee to lead a team of cataract specialists.

Dr. Bidya Pant, a leading ophthalmic surgeon, challenged this so-called eye care vacuum in a number of countries, including Myanmar, Uganda, and Nepal. His work speaks for itself. In 2016, Pant built six new hospitals, worked with a number of local monks to facilitate care, trained countless ophthalmology specialists, and completed 200,000 cataract surgeries. His high volume cataract surgery model dramatically decreased cost such that even individuals from the poorest communities in Nepal are still able to afford life-changing care.

In 1984 the population prevalence of blindness in Nepal was 0.84%. In 2015, it was just 0.35%.

Similar to Pant’s collaboration with the Myanmar monks, Mustapha, in her role as Sierra Leone’s Deputy Health Minister, has worked to increase access to eye care by training community healthcare workers who already provide maternal care, chronic disease management, vaccinations, etc. to rural communities lacking access to public health initiatives. Mustapha also advocates for a national prioritization and an integration of eye health “… into a strong health system that focuses on delivering quality healthcare that’s affordable to every Sierra Leonean across all life stages, whether they be pregnant women, babies, teenagers, adults, or elderly people, without financial consequences.”

Mustapha then posed the question: If you provide a child with a vaccine for measles or pneumonia and they later go blind from cataracts, have you really helped that child?

Of course not!

Photo from the Himalayan Cataract Project

At face value, ending preventable blindness seems overly idealistic. But, let’s return to Tabin’s “low hanging fruit” analogy. As exemplified by the work of Tabin, Mustapha, Williams, and Pant, eye care is public health’s blueberry bush. Given proper investment and government initiative, this aim is arguably realistic. It’s just a matter of enough hands reaching for and plucking berries from the bush.

I will defer to Williams who best situated the scope of their mission. He said: “You could make a serious case that there [is] no intervention… for the dollar… that would send more girls in Africa to school than cataract surgery.”

If interested, you can watch the A Vision for Ending Preventable Blindness Panel here: https://www.youtube.com/watch?v=3fSw5w2nk6k

Post by Alex Clifford, Class of 2024

Rural Exodus: An Era of Climate-Migration

By Alex Clifford

On April 21, 2023

In Climate/Global Change, Faculty

Amid fracturing arctic ice shelves, late September tempests, floods, droughts, jumping wildfires, a few decades of quick extinction and species blinking out like the quiet collapse of distant supernovae, our climate crisis has begun to displace humans en masse.

68.5 million people were forcibly displaced by climate change and disasters in 2017. By 2021, that number grew to 89.3 million people. In 2022, we reached 100 million.

In a series of articles for the San Francisco News entitled “The Harvest Gypsies,” John Steinbeck described the 1930s Dust Bowl migrants in California’s Central Valley, uprooted by drought and crumbling wheat, then later novelized in the American classic Grapes of Wrath.

Steinbeck wrote, “The new migrants from the dust bowl are here to stay. They are the best American stock, intelligent, resourceful; and, if given a chance, socially responsible. To attempt to force them into a peonage of starvation and intimidated despair will be unsuccessful. They can be citizens of the highest type, or they can be an army driven by suffering to take what they need. On their future treatment will depend the course they will be forced to take.”

Alluding to Steinbeck, Dr. Robert McLeman joined Duke’s Dr. Sarah Bermeo for Climate Change, Adaptation and Migration, a conversation on climate-migration and rural impact central to Dr. Kerilyn Schewel’s Rural Development and the Capability to Stay project.

Co-sponsored by Duke Center for International Development (DCID) and the Center on Modernity in Transition (COMIT), the lecture is part of the larger Rural Transformations speaker series, highlighting rural perspectives in the discourse around development. This objective embodies COMIT’s research as well as their cognizance of “modernity as an age of transition towards a future world society—one that will emerge not through the universalization of any existing way of life, but rather through the sustained, creative, and complexly interacting contributions of all the diverse cultures and peoples of the world.”

The Dust Bowl, McLeman pointed out, is a quintessential example of climate migration, conjuring Dorothea Lange’s depression-era photojournalism and 8th grade US history. More recently, this phenomenon has been exemplified by hurricanes Katrina, Ike, Harvey, Irma, Sandy, Ida, Hugo, Andrew, Ian, and Maria (just to name a few) with similar, though smaller scale effects.

As McLeman and Bermeo acknowledged, climate-catalyzed movement is highly dependent on complex interactions between environment, society, economy, and politics, including a myriad of non-ecological factors like “land tenure, social networks, [and] access to government programs.”

Dr. Robert McLeman is a Professor of Geography and Environmental Studies at Wilfrid Laurier University in Ontario, Canada and is the author of *Climate and Human Migration: Past Experiences, Future Challenges*

Their research on the demographic composition and rates of climate-migration answers a number of questions: who is disproportionately affected by climate change? Who is migrating? And who is participating in policy decisions?

December 2022, the Biden Administration announced a $135 million investment for relocation and adaptation planning for Native American tribes severely impacted by environmental crises, such as “coastal and riverine erosion, permafrost degradation, wildfire, flooding, food insecurity, sea level rise, hurricane impacts, potential levee failure and drought.”

In less than a lifetime, one such tribe, the Jean Charles Choctaw Nation in Terrebonne Parish, Louisiana, witnessed nearly their entire island sink into swampy silt.

The sinking of Isle de Jean Charles, National Geographic

On their tribal website, they write: “For our Island people, [Isle de Jean Charles] is more than simply a place to live. It is the epicenter of our Tribe and traditions. It is where our ancestors survived after being displaced by Indian Removal Act-era policies and where we cultivated what has become a unique part of Louisiana culture.

Today, the land that has sustained us for generations is vanishing before our eyes.”

To date, 98% of the island has sunk. The tribe has begun relocation to the New Isle 40 miles north.

Dr. Sarah Bermeo is a political economist, associate professor of Public Policy and Political Science in Duke’s Sanford School, and author of *Targeted Development.*

Climate migration in America, however, is not contained within and between states. In the past decade alone, Bermeo’s research points to a significant increase in migration from Central America to the US as well as novel patterns of family unit migration to the southern border (as opposed to a predominantly individual, male demographic in previous years). She attributes two recent droughts to this out-migration, disproportionately displacing rural communities whose livelihoods are integrally tied to subsistence farming and year-to-year crop yield.

“People leave their homes because of climate but leave their countries for other reasons,” Bermeo explained. A large percentage of climate-migration is “inter-state,” i.e. a rural coastal community is forced to move inland (but still within their country) because of dangerous erosion.

“Central America’s choice: Pray for rain or migrate. Ravaged by drought, farmers in rural Honduras and Guatemala live on the edge of hunger,” reports NBC News.

In Central America, however, there is a distinct relationship between the incidence of drought and violence. Environmental stress has catalyzed a mass exodus from rural areas, increasing urbanization, yet these cities (particularly those in Honduras, Guatemala, and El Salvador) often rank globally among the most violent, based on year-to-year per capita homicide rates.

With high levels of urban corruption and gang affiliation, it is often difficult for rural “outsiders” to find employment in the cities, leaving them unable to compensate economically for a season of crop failure. This conflict is further exacerbated by large proportions of young workers in these populations.

Despite deep-seated political polarization, climate-migration is adaptive.

McLeman described migration generally as “neither good nor bad… something that people sometimes do and always have done… [But] in North America, we lose sight of the fact that it is normal human behavior… it’s the circumstances under which it occurs that creates the challenges.”

When migration is voluntary, when people have access to social safety nets, are able to remit money to their families back home, and to mobilize legally across borders, migration is beneficial for the migrant, the migrant’s family, and the receiving community (which often benefits by filling labor demands). Often, the ramifications of immigration portrayed in the media (crime, destitution, etc.) are exacerbated by the lack of legality, social networks, and “gray markets.”

Bermeo acknowledged that the most effective mechanisms of decreasing undocumented migration are those that increase legal pathways. Historically, when the US has increased the number of visas allocated to Central American immigrants, illegal immigration subsequently decreased.

The panelists agreed: in order for both the migrating and receiving communities to benefit, we must prioritize the dignity of migrating individuals.

Though conversations surrounding climate change feel threateningly existential, Bermeo and McLeman described ways in which climate adaptation can be manageable. When migrants and rural communities are excluded from conversations and subsequent policy-making, not only do they benefit less from the proposed and funded interventions, but other communities (perhaps at less imminent risk from climate change) will still suffer from this missing insight.

Here, I return to the Jean Charles Choctaw Nation. Despite the appearance of a successful relocation project, the tribal council released a press statement in 2022, condemning the state of Louisiana. Elder Chief Albert Naquin spoke on the issue:

“If you believe that the resettlement of Isle de Jean Charles was successful, you’re headed in the wrong direction.” The memo added that, “Moving people while trampling upon our Tribe’s inherent sovereignty and rights to self-determination and cultural survival must not be viewed as a ‘success’ for future public climate adaptation investments.”

Dr. Kerilyn Schewel is a lecturing fellow at the Duke Center for International Development. She has received an award from the Social Science Research Council for her research project titled “Rural Development and the Capability to Stay.”

The mass movement of climate-migrants, from Indigenous to rural communities, represents a loss of autonomy, of land integral to identity, and often of home.

Still, Schewel’s Rural Transformation project advocates for the prioritization of these communities, rejecting the notion of passive policy-making and, instead, endorsing their active participation. Her project is indicative of how we must approach climate change adaptation: with empathy, education, and inclusion.

In a conversation with DCID, Schewel put it best: “[R]ural places are often treated as an afterthought… Some of the most promising advances in sustainable and equitable development are taking place in rural contexts, where a diversity of actors are striving to transform food systems, incorporate local knowledge, strengthen climate resilience, and widen participation in the development process.”

The DCID article ends with key insights from Schewel that encompass the Climate Change, Adaptation and Migration discussion and bear repetition: “As more focus is going towards migration, this is a project that will take very seriously the constraints on rural livelihoods and the motivations of migrants who leave rural places, while offering forward-looking solutions to advance our understanding of what it would mean to build more sustainable and flourishing rural futures.”

Next up in the Rural Transformation lecture series: Religion and Development (June 20) and Local Knowledge, Global Change (June 30)

Post-COVID Public Health is in a Trust Fall

By Alex Clifford

On February 20, 2023

In Global Health, Lecture

Dr. Heidi Larson, director of the Vaccine Confidence Project, described data from a recent Pew Center study, instructing us to “HANDLE WITH CARE!” as if a jeweled Fabergé egg and not a series of sampled statistics.

The study’s title: “Americans’ Trust in Scientists, Other Groups Declines.”

“Pew Research Center conducted this study to understand how much confidence Americans have in groups and institutions in society, including scientists and medical scientists.”
Credit to: Brian Kennedy, Alec Tyson, and Cary Funk

“Once seemingly buoyed by their central role in addressing the coronavirus outbreak,” Pew Center researchers write, the public’s trust in scientists and health professionals has sunk. This phenomenon is not confined to remote corners of Twitter or the turbulent backwaters of a few Facebook community chats. No, it’s palpable in the media, in conversation, in our collective consciousness. Why is this? And why now?

Last month, The Duke Global Health Institute hosted a few health experts to answer these questions in the “Building Trust in Public Health: A Post-COVID Roadmap” panel. Jack Leslie, a visiting fellow at the Duke-Margolis Center for Health Policy, contextualized declines in public trust, citing increased populism and anti-elitism. It’s not difficult to chart the evolution of this zeitgeist. In the past three decades alone, Americans have become completely cocooned in media.

Jack Leslie joins Duke University as a Senior Visiting Fellow at the Duke Global Health Institute (DGHI) and Visiting Fellow at the Duke-Margolis Center for Health Policy

CNN’s Ted Turner (i.e. the ‘Mouth of the South’) is accredited with the genesis of the 24 hour news cycle. He notably “didn’t bargain for… [the] insomniacs,” writes journalist Lisa Napoli, nor did he bargain for its longevity, or our inability to escape it. From coverage of the Iraq War to the OJ Simpson investigation to political partisanship in Washington, and of course, to COVID-19.

The erosion of institutional faith is not unique to the government but, like an acid rain, weathers indiscriminately. It eats away at trust in churches, corporations, media institutes, universities, K-12 schools, etc. In fact last semester, I attended another Duke panel entitled “Policing the Pages,” in which increased polarization across the US contributed to concerted efforts to bar certain books (often those with LGBT and minority characters) from elementary school libraries and syllabi. A kind of censorship akin to dress codes and mandatory veggies in bagged lunches.

This sentiment, unlike COVID-19, is not novel. Leslie described a “trifecta” of events, slowly chipping away at public trust: 1) the great recession of ‘08, 2) waves of immigration in the United States and Europe, and finally, 3) the pandemic.

For decades, and with little exception, science was lauded as infallible, an authority, bridging turbulent seas of dis- and mis-information. It was well-mannered, professorial, clad in wire-rimmed glasses and bowtie. “We had pretty high trust in scientists and public health institutions prior to the pandemic… relative to other institutions which have taken a hit over the past twenty years,” Leslie acknowledged.

Of course, this no longer is the case.

Dr. Heidi Larson is a professor of anthropology, risk, and decision science London School of Hygiene and Tropical Medicine.

Dr. Heidi Larson collected this pathos in anecdotes for the Global Listening Project, an oral history of personal pandemic experiences. Many described “…a feeling of disconnect with the government. [They] would give us these directives, but people felt they had no connection with their reality, their situation.” Larson, for example, recognized patterns of isolation in schools. There was a pervasive sense that neither legislator nor scientist had stepped foot into these schools before creating policies. Bureaucratic deflection so to speak.

Larson consequently felt a shift in COVID-19 rhetoric. What once was “upholding global unity,” “encouraging communal cooperation,” and “assuring responsive governance” became, as Larson put it, “getting a jab in the arm.” The disconnect between the Joe Publics, the John Qs, and their public institutions began to feel especially cavernous as the pandemic stretched weeks, months, then years.

This begs the question, how can we rebuild trust in public health?

Dr. Rispah Walumbe is a health policy advisor at Amref Health Africa, to support the advancement of the universal health coverage (UHC) agenda.

Dr. Rispah Walumbe, a global health policy and advocacy specialist, described the “orchestration” of multisectoral partnerships during the pandemic (in Africa, specifically) that combined “state and non-state actors with public and private sector actors and, of course, those on the social, economic, and political sides.”

She found that, at the start of the pandemic, trust was enhanced. The virus was identified as a “key problem” and was, to some degree, universally threatening. A conduit of centralized communication followed. As the pandemic elongated, the discrepancy between the populations disproportionately burdened by COVID (poor and minority communities) and those not so much grew wider. Communication became less effective. Still, Walumbe advocated for the continuity of engagement between health institutions and the public in the aftermath of the pandemic. Peel back the Oz-like bureaucratic curtains and increase transparency.

Dr. Mandy Cohen served as the Secretary of the North Carolina Department of Health and Human Services as well as the Chief Operating Officer and Chief of Staff at the Centers for Medicare and Medicaid Services. She has been elected to the National Academy of Medicine and is an adjunct professor at the UNC Gillings School of Global Public Health.

Dr. Mandy Cohen, Secretary of North Carolina’s Department of Health and Human Services, agreed. In recent studies, she explained, NC ranked 2nd among the states for its general safety during the pandemic, which she attributed to the state’s prioritization of public trust. “Before we even had our first case, we were talking about how our crisis response was going to hinge on whether we could build and maintain trust with the public… we tried to be really tactical about trust, which can feel ephemeral and fleeting… and really broke it down into three buckets. The first was transparency, the second was competency, and the third was relationships.”

Rebuilding trust in public health, thus, seems less a roadmap and more a spigot. Institutions must continue to fill the buckets Cohen described.

As the pandemic ebbs, however, the ubiquity of isolation, anxiety, and turmoil cannot be understated. A recent WHO article characterized this pervasive fear as “contagious,” pathologic, a kind of virus itself.

In this political cartoon, Sisyphus pushes a stone (the Delta variant) up the hill

In an age of mass misinformation, public health officials, doctors, and scientists now stand with the Sisyphean task of restoring public trust. And the panelists concurred: it is fragile. Volatile even.

Yet, as illustrated in this article, it is not elusive. Prioritize communication. Prioritize transparency. Prioritize competency, relationships, and community engagement.

I will defer to Walumbe who put it best during the conversation: “These institutions do not operate in a vacuum. Community is pivotal in thinking through trust, it’s how we’re organized across the world… that’s something that is critical in how we approached COVID-19 challenges…” and, presumably, in how we should continue.

Thank you to the panelists, moderator Dr. Krishna Udayakumar, and Dr. Mark McClellan, Director and Robert J. Margolis, M.D., Professor of Business, Medicine and Policy at the Margolis Center for Health Policy.

Post by Alex Clifford, Class of 2024

Library Shakedowns: Book Bans and Censorship

By Alex Clifford

On December 5, 2022

In Humanities, Responsible Conduct

“I started thinking about how I might be different, how my life might be different, how my conversations might be different, if [‘To Kill a Mockingbird’] had not been a book that I was able to read in the 8th grade… to keep reading and reading again,” recounted Professor Kisha Daniels in her opening remarks of last month’s “Policing Pages” panel.

Professor Kisha Daniels is an Assistant Professor of the Practice of Education at Duke University and the moderator of Duke Alumni *Lifelong Learning* “Policing Pages: The American Classics” event.

What truly is more formative in the awkward, acned stretch of middle school than Lip-Smackered gossip and English class? Yellow page paperbacks, palimpsests of doodles and students from years past. Purchased on teacher budget scraps and booster club wrapping paper sales, Shakespeare, Orwell, a hundred used copies of “Tuck Everlasting”: stained, dog-eared, and coverless.

Psychology and neuroscience researchers agree that reading (and, thus, books like “To Kill a Mockingbird”) weaves tapestries of yarny neurons and synapses, beneficial for the development of social-emotional skills, empathy, and creativity during childhood and adolescence.

Yet, America has recently witnessed persistent efforts to ban certain titles from K12 schools. In 2004 and 2005, for example, Stanford Middle (here in Durham) challenged the inclusion of “To Kill a Mockingbird” in its own library, citing the novel’s use of racial slurs.

It ultimately was not removed from the shelves, but the book remains one of the most challenged/banned titles in U.S. school history.

Professor Sarah Ludington, a Duke Law faculty member and director of the First Amendment Clinic

In 2021, the American Library Association reported an unprecedented 729 book challenges. So why, Daniels prompted, are we seeing such a high number of banned books? And why now?

Before answering this, Professor Sarah Ludington clarified some of the misleading rhetoric propagated by the popular media. “’Banned books’ is more of a slogan,” she explained. More accurate is the idea of challenging a book, whether in a library or on the class curriculum. This does not necessarily mean the book will be outright banned or even removed from the shelf or, if it is banned, permanently. In fact, books can be reinstated, even after their removal, back to their shelf and the occasional dust bunny.

In North Carolina, such a statute exists in state law that bars an individual, like a single librarian, teacher, or parent, from undemocratically removing or banning a book. Instead, local administrative boards must take a vote.

PBS’s “Books Behind Bars”
Illustration by: Jane Mount

University Librarian Joseph Salem argued that social media platforms, like Facebook, and online groups, like Moms for Liberty, create tectonic shocks that trigger tidal waves of book challenges. They’re echo chambers: amplifying calls to remove specific books from school libraries, ping-ponging literary “hit-lists” through cyberspace with titles such as: “The Handmaid’s Tale” by Margaret Atwood, “Of Mice and Men” by John Steinbeck, “The Kite Runner” by Khaled Hosseini, and “Beloved” by Toni Morrison (you can take a look at the full list here).

Joseph Salem is Duke’s newest University Librarian and Vice Provost for Library Affairs

These books disproportionately feature marginalized voices and are often “charged and sentenced” for containing “LGBTQ content, profanity, and/or sexual references.”

As we’re all aware, what once was local news can quickly leach into national discourse. A book ban in a rural Ohio county, for example, can be picked up by the local media, trend on Twitter, disseminate through Facebook until someone, say, in Texas or Arkansas or North Carolina decides they too want to challenge said book in their own school district.

This book-banning rhetoric and its implications are present elsewhere in education-related conversations. Take, for example, Florida’s dubbed “Don’t Say Gay” bill. In March, lawmakers in the Sunshine State argued that merely mentioning sexual orientation/gender identity in primary school settings is grounds for a lawsuit on the basis that such content is innately “sexually explicit,” no matter its context.

However, challenging certain books and even passing certain laws are usually not intentionally malicious acts. It is indisputable that some books simply do not belong on school bookshelves. A medical textbook, Ludington analogized, wouldn’t make sense in a library for children just learning how to read. But, in a high school with a more mature student body, its inclusion wouldn’t bat an eye. Further, in the U.S. more generally, First Amendment rights do not extend to all forms of speech anyways, including but not limited to “obscenity, child pornography, fighting words, and the advocacy of imminent lawless action.”

And though societal concern over the well-being of children is well-intentioned, it can often be misguided or out-of-proportion.

I don’t think it’s too outrageous to consider children as sentient and receptive, whether to new ideas, new perspectives, and/or new people.

Still, in the United States, a number of moral panics, concerning everything from poisoned Halloween candy to “Dungeons & Dragons” to subliminal messaging in rock music to Tide Pods, have been cause for parental concern.

In 1985, for example, Tipper Gore bought Prince’s “Purple Rain” album for her 11-year-old daughter and was shocked by its age-inappropriate lyrics. She took her concern to the Senate in a series of Congressional hearings which, though largely mocked, called for a music rating system like the kind adopted by Hollywood for movies.

In 1985, Dee Snider, Frank Zappa, and John Denver (from left to right respectively) testified before the Senate against music censorship and the Parents Music Resource Center (P.M.R.C.). Notably, John Denver advocated for his song “Rocky Mountain High.“

Dee Snider, Frank Zappa, and John Denver somehow managed to assemble into the eclectic “primary counsel” for the musical defense and eloquently argued that labeling and banning albums is akin to censorship.

Gore’s campaign was ultimately unsuccessful.

But, it’s not difficult to see how censorship concerns voiced in the Senate in the 80s mirror the ones voiced today.

Ludington, a self-proclaimed First Amendment enthusiast, added that “…inherent in our idea of freedom of speech is this notion that truth emerges from robust dialogue… The best way to counteract whatever pernicious effect there might be, say from a book that you wanted to ban, is actually to read the book and reason against it.”

This kind of civil discourse is an idealism baked into the “apple pie” of American democracy. Quite arguably the Golden Delicious themselves. Over the course of U.S. history, there have been just and unjust efforts to suppress individuals’ freedom of speech. Take the infamous “yelling FIRE in a crowded theater” anecdote.

Experts concur, however, that most censorship is unproductive and often does little to actually stymie the ideas it so desperately wants to quash. In fact, as Daniels pointed out, banning books from school libraries typically does not decrease their readership and can actually drive their sales up.

But the implications of book banning run deep, implying that, as a society, there is little value in responsibly harboring and learning from certain (and often difficult) materials.

Salem described a collection on hate groups, gathered by the Southern Poverty Law Center and possessed by the Duke University library. He said, “If we take a step back for a moment and think that everything in the Duke University library… is something we endorse without understanding the complexity of why we might have it, either to learn from it as a good or bad example… one might say that owning or stewarding means that we support what’s in that collection. I would push back on that vehemently. It doesn’t comport with our values at all.”

After book banning efforts in school libraries reached an all time high in 2021, 2022 is trending to exceed last year’s figure.

Instead of arguing with disgruntled parents and Facebook groups, many underpaid librarians and teachers, Salem described, choose to self-censor, quietly removing contentious titles from their shelves to avoid unfair accusations lobbied at them in heated PTO meetings, over angry phone calls, or during school board votes.

To oppose this form of censorship, Daniels, Ludington, and Salem agreed: Read the books! Parents, Facebook group members, and legislatures alike, read before challenging, before banning, and then after banning. Reading is really the preeminent way to avoid unnecessarily suppressing free speech in schools; to introduce yourself to new ideas, to new discourse, and to new perspectives. Daniels put it best, “The book is innocent until proven guilty.”

Give it a fair trial.

In Harper Lee’s “To Kill a Mockingbird,” Atticus describes empathy to Scout in a way which resonates with many of the “Policing Pages” talking points, saying: “You never really understand a person until you consider things from his point of view… until you climb into his skin and walk around in it.”

If interested in the “Policing Pages: The American Classics” discussion, click here to watch.

If interested in resources on book banning, check out the American Library Association for more information.

American Epidemics and the Viral Underclass

By Alex Clifford

On October 26, 2022

In Global Health, History, Lecture

March 2020. The subsequent blur of months. Of spring into summer, fall into winter, a year into another and likely into the next. Like millions of humans around the world, 2020 itself feels infected, as if wrapped up with yellow caution tape. Virus dominates the current zeitgeist; pandemic won Merriam-Webster’s 2020 word of the year; vaccine in 2021.

We are all proto-virologists, sludging through the constant slew of “viral” media: novel variants, outbreaks, booster shots, mutations (a jargon in which we’re collectively fluent).

Monkeypox on the left, COVID-19 on the right.

In the somewhat-receding wake of COVID-19, like floodwater, viral fear recently surged again when the World Health Organization began reporting monkeypox (MPX) outbreaks in Europe and North America. The stigmatization of MPX patients as “disease-spreaders” (in the media, on the internet, in conversation, etc.) suggests these individuals have a kind of authority over the virulent strands of DNA in their bodies. This belief aligns with the etymology of “virus” from the Latin “poison,” a word that functions as both noun and verb. Passive and active. Culpable.

Alan Krumeweide in *Contagion* (Claudette Barius / Warner Bros.)

I’m reminded of Jude Law’s fear-mongering character in Contagion, Alan Krumewiede, the conspiracy theorist who conjectured MEV-1, the film’s fictional virus, was “Godzilla, King Kong, Frankenstein, all in one.”

Of course, this sentiment did not bud from MPX or COVID-19 like a novel variant. No, it has existed in the United States for decades, if not longer, and it has not been dormant.

Dr. Stephen Thrasher, a scholar of the criminalization of HIV/AIDS at Northwestern University, stood in Duke’s anthropology lecture hall this month and drew parallels between the recent MPX/COVID-19 epidemics and that of HIV/AIDS in the 1980s-90s and stretching into the new millennium. He asked us to raise our hands if we personally knew someone with HIV/AIDS. A few did. If we knew someone who had died from HIV-related causes. A few less. What about COVID? The entire audience raised hands as if to signal the new era of viral infection.

Dr. Steven Thrasher is the inaugural Daniel H. Renberg Chair of social justice in reporting (with an emphasis on issues relevant to the LGBTQ community) and an assistant professor of journalism at Northwestern. His research focuses on HIV in America.

Since the start of the HIV/AIDS epidemic in 1981, more than 700,000 people have died from HIV-related illness in the United States, a disproportionate number of whom were men who had sex with men and injection drug users (with poverty exacerbating the likelihood of acquisition).

As Thrasher historicized, the stigma that encapsulated HIV/AIDS significantly delayed life-saving interventions on the local and national scale. Prejudice hindered research funding, drug distribution, and government health agency mobilization. The rising tide of the HIV/AIDS epidemic was concurrent with increased violence towards the LGBTQ community, and gay men in particular, analogous to a king tide flooding the coastline.

Thrasher exemplified this taboo through the “patient zero” misconception, which was propagated by the media during the epidemic and embedded like a splinter in pop culture’s thumb (i.e. the film Patient Zero with Matt Smith, Stanley Tucci, and Natalie Dormer).

Gaëtan Dugas was miscredited as Patient Zero of the HIV/AIDS epidemic in America
Credit: Fadoo Productions

Gaëtan Dugas, a Québécois Canadian flight attendant, was inappropriately labeled “patient zero” of the HIV/AIDS epidemic in America. As Thrasher and other researchers have debunked, Dugas was, in fact, not the first person to bring HIV to the United States. Further, Dugas was not even included in the early infection group. And Dugas was Patient O (like oh), not zero, for Out-of-State. Yet, this contextualization of the virus endures despite being disproved. Upon diagnosis, many infected individuals will experience shame.

In the 1980s and 90s, HIV/AIDS was characterized as the “gay plague,” setting ablaze a moral panic in America comparable to that of the Satanic Panic, rock ‘n’ roll, and fear of razor blades stuffed into gooey 3 Musketeers bars at Halloween (and there’s an interesting overlap in the timing of these hysterias in the collective American consciousness). And just two months ago even, many people were characterizing MPX in the same accusatory and morally dubious way.

Like with the AIDS epidemic, Thrasher said the US government failed to mobilize public health initiatives early enough to proactively stifle MPX outbreaks in spite of the disease’s well-documented diffusion across Europe and into neighboring Canada.

“We could’ve tapped the Strategic National Stockpile,” he argued. Thrasher listed multiple public health interventions that could have and should have been implemented with the first faint smoke signals of MPX in the United States (as they were in the past for meningitis and polio outbreaks).

For context, the Strategic National Stockpile (SNS) is a cache of medicines, antibiotics, and vaccines that the government started to accumulate just prior to 9/11 in 2001 and, seemingly, in an exponential manner after — almost like doomsday preppers hoarding freeze-dried beef stroganoff and cans of beans in their underground bunkers. Born from the smoking rubble and smoke of New York City following the terrorist attack, fear of biological warfare, especially the weaponization of smallpox, paralyzed the US (i.e. the Anthrax scare).

The SNS was tapped after 9/11, for 12 major hurricanes, COVID-19, and the swine flu (to name a few), but not for monkeypox.

As historically evidenced, mass vaccination and herd immunity effectively prevent the spread of viral infections, especially for slow-mutating viruses like MPX.

“We should have quickly vaccinated queer men and transmasc people,” Thrasher said, “building on a very historic anomaly which is that adults have been socialized to take vaccines en masse in a way that has not happened in many decades.” And because MPX and smallpox are closely related viruses, a rollout of the stockpile’s smallpox vaccine could have nipped the outbreak in the bud.

But, the SNS was not tapped. 100 million doses remain stockpiled. There are nearly 28,000 total monkeypox cases documented in the United States.

A large focus of Thrasher’s research is on who is affected by viruses, and how, and why. Nearing 6.6 million COVID-19 deaths worldwide, many would argue that viruses — these ancient, non-life forms — are Earth’s “great equalizers,” as acknowledged by Thrasher in multiple publications. Evolution has pushed them to infect, replicate, and spread: machine-like and non-discriminatory.

But, he added, viruses are not great equalizers. Infection is inherently unequal. Again, we must ask the question who?

Thrasher’s book *The Viral Underclass: The Human Toll When Inequality and Disease Collide* was recently long-listed for the 2023 Andrew Carnegie Medal for Excellence in nonfiction.

Viral infections disproportionately burden marginalized bodies and communities, a concept Thrasher framed as the viral underclass (coined by activist Sean Strub and reshaped by Thrasher to describe this phenomenon). Writing in his book of the same name, “… the viral underclass can help us think about how and why marginalized populations are subjected to increased harms of viral transmission, exposure, replication, and death.”

Let’s return to the MPX vaccine. The Biden administration did not tap the SNS for mass vaccination. Instead, it rolled out meager health interventions at a snail’s pace (like Sisyphus pushing his stone up the hill). Still, many at-risk individuals, in particular men who have sex with men, opted to receive a two-shot regimen to protect themselves from the virus. Considering the viral underclass, Thrasher posed the following questions:

Who is disproportionately burdened by MPX in the US? He answered, “Black and Latino men who have sex with men.”

And, who is receiving the medical interventions to protect themselves from the painful infection? He answered again, “I got one MPX vaccine shot, almost everyone in line but me and a friend were white.” He describes the discrepancy between those receiving the vaccine and those most at-risk of acquiring MPX in his Scientific American article “Monkeypox Is a Sexually Transmitted Infection, and Knowing That Can Help Protect People.”

And his years of HIV research corroborate this trend.

From the *New York Times*, Michael Johnson has been working to overturn laws criminalizing HIV in the United States.

He spoke (and wrote in The Viral Underclass) about his time reporting the Michael Johnson court case in St. Louis, Missouri. Michael Johnson, a black, gay, former college wrestler, was sentenced to 30 years in prison after failing to disclose his HIV status to his sexual partners — a criminal offense. The prosecution had sought a maximum 60.5 years, practically a life sentence.

For context, in the state of North Carolina, the maximum sentence for voluntary manslaughter is a little under five and a half years. In the courtroom, Thrasher was privy to the prosecution’s smoking gun: Johnson had previously signed a legally-binding acknowledgment of his HIV diagnosis. With the flick of a pen, nondisclosure was a criminal offense.

In his interviews, however, Thrasher found that Michael Johnson was semi-illiterate and had not been properly informed of the legal implications of the document he had signed. Nor had he been informed of the consequences of breaking the legal contract. Nor had he been counseled or given any legal advice prior to being charged.

Michael Johnson was released from prison 25 years early after his ruling was overturned. His is a body in the viral underclass.

Excerpted from Thrasher’s book *The Viral Underclass: The Human Toll When Inequality and Disease Collide*

Vito Russo speaks at the 1988 ACT UP demonstration at the Department of Health and Human Services in Washington, D.C.
Credit: Rick Gerharter/HBO Documentary Films

Concluding his lecture, Thrasher quoted AIDS activist Vito Russo’s Why We Fight speech from the 1988 ACT UP Demonstration at the Department of Health and Human Services. In reading the entire transcript, I found that Russo was aware of the viral underclass, as Thrasher theorized, despite the term not yet existing in the academic ethos. He said in his address:

“If I’m dying from anything — I’m dying from the fact that not enough rich, white, heterosexual men have gotten AIDS…. Living with AIDS in this country is like living in the twilight zone. Living with AIDS is like living through a war which is happening only for those people who happen to be in the trenches. Every time a shell explodes, you look around and you discover that you’ve lost more of your friends, but nobody else notices. It isn’t happening to them.”

Is it possible to ever resolve the viral underclass in the US? As long as systemic inequities continue to exist, no. This may seem pessimistic or even cynical, but Thrasher concluded his lecture (and his book) with reserved optimism. “Let’s get to work,” he implored.

If we can identify and actively dismantle the systems that disproportionately burden certain populations with viruses and diseases, like a spool of yarn, we can begin to unravel the viral underclass in America.

Yes, infections should be treated with accessible and affordable medicine. Yes, healthcare should be expanded. Yes, we should continue to improve the efficacy of drugs and diagnostics. But, health interventions alone do not cure communities of disease.

Thrasher found that marginalized bodies will continue to be infected, in spite of medicinal intervention, if the inequities from which the viral underclass emerge are not concurrently cured. Let’s get to work.

If interested, here’s a link to Thrasher’s website and book: http://steventhrasher.com/

Post by Alex Clifford, Class of 2024

Is it Time to Decolonize Global Health Data?

By Alex Clifford

On October 14, 2022

In Global Health, Responsible Conduct

In the digital age, we are well-acquainted with “data,” a crouton-esque word tossed into conversations, ingrained in the morning rush like half-caf cappuccinos and spreadsheets. Conceptually, data feels benign, necessary, and totally absorbed into the zeitgeist of the 21st century (alongside Survivor, smartphones, and Bitcoin). Data conjures up the census; white-coat scientists and their clinical trials; suits and ties; NGO board meetings; pearled strings of binary code; bar graphs, pie charts, scatter plots, pictographs, endless excel rows and columns, and more rows and more columns.

However, within the conversation of global health, researchers and laymen alike would more often than not describe data collection, use, and sharing as critical for resource mobilization, disease monitoring, surveillance prevention, treatment, etc. (Look at measles eradication! Polio! Malaria! Line graphs A, B, and C!)

Thanks to the internet, extracting health data is also faster, easier, and more widespread than ever . We have grown increasingly concerned, and rightfully so, about data ownership and data sovereignty.

Who is privy to data? Who can possess it? Can you possess it? As you can see, the conversation quickly becomes convoluted, philosophical even.

Dr. Wendy Prudhomme O’Meara is an associate professor at Duke University Medical School in the Division of Infectious Diseases, visiting professor at Moi University, and the Co-Field Director of Research for AMPATH. Her research focuses on malaria.

Dr. Wendy Prudhomme O’Meara, moderator of the Data as a Commodity seminar on Sept. 29 and associate professor at Duke University Medical School in the Division of Infectious Diseases, discussed bioethical complexities of data creation and ownership within global health partnerships.

“We can see that activities—where data is being collected in one place, removed from the context, and value being extracted from it for personal or financial benefit — has very strong parallels to the kind of resource extraction and exploitation that characterized colonization,” she said in her introductory remarks.

Data, like other raw materials (i.e. coffee, sugar, tobacco, etc.), can be extracted, often disproportionately, from lower-middle income countries (LMICs) at the expense of the local populations. This reinforces unequal power dynamics and harkens to the tenets of colonialism and imperialism.

This observation is exemplified by panelist Thiago Hernandes Rocha’s research which focuses on public policy evaluation and data mining. He acknowledges that global health research, in general, should prioritize the health improvements of the studied community rather than publications or grant funding. This may seem somewhat obvious to you; however, though academic competition often fosters nuances in the field, it also contributes to the commercialization of global health. Don’t be shy, everyone point your finger at Big Pharma!

Though Dr. Rocha’s data mining technique refers to “pattern-searching” and analysis of dense data sets, I find “mining” to be an apt analogy for the exploitative potential of data extraction and research partnerships between higher income countries and LMICs.

Dr. Thiago Hernandes Rocha joins the discussion via Zoom. He is an advisor on health data analysis for the Pan American Health Organization.

Consider the British diamond industry in Cape Colony, South Africa, and the parallels between past colonial mineral extraction and current global health data extraction. Imagine taking a pickaxe to the earth.

Now consider the environmental ramifications of mining, and who they disproportionately affect. Consider the lingering social and economic inequalities. Of course, data is not a mine of diamonds (as your Hay Day farm might suggest) nor is it ivory or rubber or timber. It’s less tangible (you can’t necessarily hold it or physically possess it) and, therefore, its extraction also feels less tangible, even though this process can have very concrete consequences.

Data as a power dynamic is a rather recent characterization in academic discourse. Researchers and companies alike have pushed the “open data” movement to increase data availability to all people for all uses. You can see how, in a utopian society, this would be fantastic. Think of the transparency! I’m sure you can also see how, in our non-utopian society, this can be exploited.

Dr. Bethany Hedt-Gauthier, a Harvard University biostatistician and seminar speaker, described herself as “pro ‘open data’ … in a world without power dynamics” — an amendment critical to understanding research as a commodity itself.

She justified her stance by referencing the systematic review of authorship in collaborative health research in Africa that she conducted in collaboration with others in the field. They found that even when sub-Saharan African populations were the main sites of study, when partnered with high-income, elite institutions (like Duke or Harvard), the African authors were significantly less likely to be first or senior authors despite the comparable number of academics on both sides of the partnership. To what can we attribute this discrepancy?

Dr. Bethany Hedt-Gauthier is a biostatistician in health systems research that focuses on the optimization of care and health outcomes in sub-Saharan Africa.

Dr. Hedt-Gauthier describes forms of capital that contribute to this issue, from cultural capital (i.e. credentials) to symbolic capital (i.e. legitimacy) to financial capital; however, she poses colonialism (and its continuity in socioeconomic and political power dynamics today) as the root of this incongruity from which the aforementioned forms of capital bud and flower like poisonous oleander. In recent years, institutions, including Duke, have increased efforts to “decolonize” global health to achieve greater equity, equal participation, and better health outcomes overall.

Dr. Hedt-Gauthier briefly chronicled some of her own research in Rwanda at the start of the COVID-19 pandemic. Within her research partnerships, she recollected slowing down, thoughtfully engaging in two-way dialogue, and posing questions like the following: “Who is involved [in the partnership]?” “Are all parties equally represented in paper authorship?” “If not, how can we share resources to ensure this?” “How can we assure that the people involved in the generation of data are also involved in the interpretation of its results?” “Who has access to data?” “What does co-authorship look like?”

Investing time and energy into multi-country databases, funding collaborative research infrastructures, removing barriers within academia, and training researchers are just some of the methods proposed by the speakers to facilitate equitable partnerships, data sharing and use, and continued global health decolonization.

Dr. Osondu Ogbuoji is an Assistant Research Professor at Duke Global Health Institute (DGHI) and Deputy Director at the Center for Policy Impact in Global Health at DGHI.

Dr. Osondu Ogbuoji, the final panelist, puts it best: “… We should ensure that the people in the room having the discussion about what values the data has should be as diverse as possible and ideally should have all the stakeholders. In our own research, sometimes we think we have an idea of what data to collect, but then we talk to the country partners and they have a totally different idea.”

Though the question of data ownership may feel lofty or intangible, though data legality is confusing, though you may feel yourself adrift in the debate of commodity and capital, the speakers have thrown you a buoy, grab on, and understand that generally:

It is necessary to engage with “data” in a communicative and critical manner; it is necessary to build research partnerships that are synergistic and reciprocal; and, finally, it is necessary to approach global health via these partnerships to advance the field towards greater equity.

Post by Alex Clifford, Class of 2024

Watch the recorded seminar here: https://www.youtube.com/watch?v=wRmFzif8a1c

Meet New Blogger Alex: Pipetting Writer from Coastal SC

By Alex Clifford

On September 20, 2022

In Art, Biology, Fossils, Science Communication & Education, Students

When I write about myself, it always reads like a poorly crafted match.com zinger. Boring, awkward, and something along the lines of:

I’m Alex. Aquarius. Love dogs, classic rock, old NCIS episodes. $1 Goodwill paperback thrillers, marked with “Happiest 53rd Richard! All my love, Janet” and “8/17/2005, Saw this and thought of you!” And I like to ask myself why Steven King’s Carrie conjures up thoughts of said person? Who’s Richard? How’s Janet?

I also love coffee. And tea. Peppermint, of course. Irish breakfast, sure. Chamomile, why not. But I think I really just like collecting mugs — hearty ceramics, dainty porcelain, hand-painted, non-dishwashable, chipped, stained monstrosities. It might be a problem though (as I don’t have much shelf space).

Favorite genre of film? It’s got to be anything in the Meg Ryan romcom cinematic universe. Or the Brat Pack coming-of-age cannon. Breakfast Club, St. Elmo’s Fire, About Last Night, Pretty in Pink. Really just the Judd Nelson je ne sais quoi.

My dog and I celebrating her 11th birthday this summer!

I think my 2nd grade superlative was “Wormiest Bookworm,” whatever that means. That might’ve been the year I read every Nancy Drew book in the library and founded the neighborhood’s first and only detective business. I do wish I could say I’ve Jules Verne’d the world in 80 days — circumnavigating all five nebulous oceans, frozen Arctic plains, Swiss peaks, and continental slopes; Phileas Fogging my way through the Mediterranean, aperitivo in hand. But I’m a bit unworldly in the geographic sense. I’ve only been out of the country once to boat up next to Niagara Falls, wearing a thin, plastic poncho and an I <3 Canada tee (though I’ve possibly made it a second time to Canada after getting lost on the circumference of a lake in Vermont).

I’ve only ever lived in Charleston, SC, never straying too far from its labyrinth of intercostals and waterways, its Theseus-like shrimpers, gliding into port. At Duke, I spend half my time majoring in molecular/cellular biology and the other lamenting my landlockedness, missing Charleston’s temperate sea breeze.

Growing up there was all briny inlet and Waffle House, midnight bacon, butter pats, cordgrass, molting blue crab, churches on every street corner and in every denomination, weak coffee and greasy hash brown breakfast, September hurricanes, salt, cicadas, farm stands packed with peaches, a once-in-a-hundred year 6-inch snowfall that closed school for two weeks.

On Saturdays, I sharktooth-hunted with my sisters in pluff mud plots now developed (strangers tend to find the smell of the marsh pungent, but I think it’s character building). Fished for red drum. Searched for pearls in half-mooned oyster mouths. Kayaked down creeks.

Charleston’s a literary city, or so I’ve always heard. I think Edgar Allen Poe’s ghost haunts a cobble-stoned alley downtown or something like that. And if not an alley then a quaint B&B, its porch bearing creaky rocking chairs and purple coneflower. I went to an arts-specialized middle and high school for creative writing, wrote some bad poetry in my formative years and a couple of questionable short films, then went to college and somehow fell into the field of cell bio and now I spend a decent chunk of my free time researching genetic heart disease in a campus lab. Feeding cardiomyocytes via gentle pipette like they’re sea monkeys.

I like to picture the act of writing and that of science as similar — fraternal twins or first cousins — and I don’t think it a coincidence that early philosophers were our first physicians, mathematicians, physicists, chemists, etc. Both fields challenge us to pose questions about our world, about its inhabitants, its oddities, its nuances. We just go about answering them differently.

For this reason, I’m incredibly excited to join Duke’s Research Blog, to write about science and innovation, to poeticize protein structures or to search for lyricism in neuronal action potentials the way a deep sea troller searches for the elusive giant squid. I just think there’s something so wonderful about learning new things, cradling little curiosities that often lead nowhere, and doing so through an accessible, enjoyable medium.

Post by Alex Clifford, Class of 2024

Following the people and events that make up the research community at Duke

Author: Alex Clifford

It’s a Bird… It’s a Plane… It’s Comic Medicine!

Doctors Share a Vision for Ending Preventable Blindness

Rural Exodus: An Era of Climate-Migration

Post-COVID Public Health is in a Trust Fall

Library Shakedowns: Book Bans and Censorship

American Epidemics and the Viral Underclass

Is it Time to Decolonize Global Health Data?

Meet New Blogger Alex: Pipetting Writer from Coastal SC