Category: Global Health Page 1 of 15

It all starts with a simple question: How can I help? For some Duke students, the answer meant taking initiative – transforming empathy into action, ideas, and impact in order to tackle the most pressing global health issues head-on.

On April 10, 2025, two Duke teams were among 22 semi-finalist teams, representing 18 universities across eight countries, who met at the 15th Annual Global Health Technologies Design Competition on the Rice University campus. There, the students exchanged their strong passions about global health and learned from one another’s efforts to address the needs of low-resource communities. The projects spanned a wide spectrum of challenges, from portable glaucoma detection devices for applications in rural Peru, to low-cost sensor-based gloves for translating sign language into voice in real time, and many more!

*The Awards at the Rice360 Global Health Technologies Design Competition*

The competition was hosted by the Rice360 Institute for Global Health Technologies, a multi-disciplinary institute that aims to elevate global health technology education and research. Following their mission, this event helped to raise awareness about students who are leading global health innovation. Moreover, participating students received the opportunity to engage with judges, mentors, and interested attendees with expertise in global health for vital feedback and recommendations for future project plans.

The two Duke teams that qualified as semi-finalists were HemoSave and VenAlign. HemoSave was awarded first place for their project targeting the leading cause of maternal mortality worldwide, an excessive loss of blood after childbirth called postpartum hemorrhage. To combat this critical issue, the HemoSave team designed a cost-effective blood loss tracking device that uses colorimetric and gravimetric analysis. By doing so, the device allows clinicians to accurately measure blood loss during C-sections to improve high-stakes decision-making in low-resource settings. All components of the design were locally sourced from Kampala, Uganda, to maximize affordability and accessibility within such low-resource settings.

*Representatives from the Duke University HemoSave Team, Haasini Nandyala and James Bradley*

Second place was awarded to QBiT A.R.M. from Queen’s University for their work on developing low-cost, 3-D printable arm prosthetics. Their open-source design allows “clinics in lower- and middle-income countries to produce prosthetics on-site, restoring mobility and independence for those in need” (Rice360).

BiliRoo from Calvin University won third place for their device that combines filtered sunlight phototherapy technology and skin-to-skin contact between parent and child to treat neonatal jaundice in low-resource settings. For more information and to learn about the rest of the other incredible projects, please refer to the Rice360 website (link).

In addition to the student competition, Rice360 honored two current leaders in Global Health this year for their continued perseverance and successes within innovation for Global Health. The two recipients for the Rice360 Innovation and Leadership in Global Health Award were Dr. June Madete and Dr. Patty J. García, both successful leaders of global health in their own right.

After noticing a disheartening lack of biomedical engineering in Kenya, Madete realized the necessity of applying her scientific experience to advancing biomedical adoption within sub-Saharan Africa. She is now a senior lecturer and researcher at Kenyatta University, where she leads education efforts in engineering to connect with students, lecturers, scientists, and industry all across Africa.

*Dr. García presenting as a Keynote Speaker*

García has also dedicated her career to advancing global health, but through a more public policy perspective. As the former Minister of Health in Peru and former Chief of the Peruvian National Institute of Health, García worked to translate critical biomedical research into real-world applications across Peru and Latin America. Her work to improve research on and the quality of health services surrounding reproductive health and sexually transmitted infections has worked to improve the safety and well-being of critical communities and vulnerable populations.

As the keynote speakers, Madete and García shared their distinct journeys across opposite sides of the globe, each grounded in a common goal to advance the well-being of underserved communities through global health innovation and education. Altogether, the students, speakers, and supporters at this year’s Rice360 competition demonstrated that meaningful change is already in motion, driven by hope for a healthier, more equitable world.

This image has an empty alt attribute; its file name is photograd.png — *By Monona Zhou, Class of 2028*

Posters Galore and More: Undergraduate Research in the Spotlight

By Stone Yan

On April 14, 2025

In Animals, Global Health, Medicine

Biomedical engineering. Climate science. Political science. Global Health.

While these departments are housed in buildings far from each other on campus, their current research was all spotlighted at the Duke Undergraduate Research Symposium on April 10. Over the course of two hours, 120 budding researchers presented their work in Penn Pavilion, eagerly chatting with peers, faculty, and community members alike.

Presenters, friends, and community members gathered in Penn Pavilion to hear opening remarks from the Undergraduate Research Support Office’s director.

The level of professionalism was obvious upon a glance at the poster titles. The symposium was strongly represented by the biomedical and health sciences; hence, membrane receptors and transport proteins bearing combinations of letters and numbers populated the majority of posters. However, many projects shared findings unrelated to enzymes or transgenic models: posters investigating “The Undocumented Republican Latino Vote” and “Palimpsest and Identity in Hong Kong” attracted as much attention.

I began my journey by talking to Eduardo Fadul Chavez, a junior who is researching chemistry. He gave me an invigorating talk on Nedd4 E3 ligase ligands (a field I admittedly have no background knowledge in). What was greatly appealing about his presentation was his focus on the relevance and impact of his team’s work, especially in innovating treatments for Parkinson’s and other cancers. “Yes, we hope to apply our findings from a pharmacological perspective,” Chavez said. “Nedd4 plays an important role in Parkinson’s disease, so figuring out how to inhibit its activity can greatly inform therapeutic development.”

Chavez’s poster on his work on Nedd4 ligase ligands, which play a role in Parkinson’s disease.

After this inspiring talk aiming to improve health and cure ailments from a biological perspective, I wandered around in search of a project looking into the sociocultural perspective. Walking across the room, I encountered Austin Brown and his colleagues presenting their work with the Help Desk.

“The Help Desk is a student-led initiative seeking to tackle social determinants of health,” Brown told me. The organization began as a Bass Connections project and has since attracted hundreds of student volunteers. Currently, about 50 volunteers work across three sites: the Duke Hospital Emergency Department, the Duke Endocrinology Clinic, and the Lincoln Community Health Center. “If patients screen positive on the background survey provided, our community resource navigators will provide support by connecting them with local organizations and follow up after the appointment to ensure they are doing well.”

The Help Desk has reached more than 3,200 patients since its inception, Brown said. Maintaining communication with patients after the initial meeting or appointment can be tricky, however. “Our biggest barrier is retention and keeping the channels of contact open,” Brown said.

By this point, I was already amazed by the depth and impact of my peers’ research. I was only more impressed when I came across the poster of Millie Evonlah, who presented on the impact of paternal cannabis consumption on adolescent offspring glutamatergic and cholinergic systems. Given the rise in recreational marijuana usage and legalization, there is a great need to study the impact of men’s usage, particularly intermittent usage, on their children’s brain regions regulating immune and cognitive function.

Evonlah in front of her poster on paternal cannabis exposure effects on adolescent offspring

“We hypothesized that there would be different expression results and responses between male and female offspring,” Evonlah said, “and our findings support this claim.” While there was decreased glutamatergic expression in the CA3 hippocampal region in both male and female offspring, males and females experienced increased acetylcholine expression in different brain regions. Additionally, only the “weekenders,” or animal subjects who partook in intermittent cannabis exposure, imparted significant biological alterations in their offspring’s brains.

All these presentations were inspiring to listen to, and selecting the few to cover in detail was a difficult task. However, I would be amiss not to mention a few other invigorating presentations I listened to. For instance, Michael Wang, who studied GRK-2 mediated regulation of brain-derived neurotrophic factor in the ischemic heart, and I had a lengthy conversation about daily research activities and cell culturing principles. I also had a spirited discussion with Madeline Morrison and her co-presenters, who talked about their experiences conducting fieldwork in Roatán, Honduras, and their perspectives on the importance of global health research.

After two hours of interacting with student researchers, it was clear to me that Duke’s research efforts indeed transform, improve, and save lives. The undergraduate student body’s collective desire to pursue scientific discovery, clinical innovation, and sociocultural advancement is a motivating force that cannot be understated.

In this season, let us all spring into research!

Could Restoring Forests Reduce Disease Risk? A Case Study of Hantavirus in Madagascar

By Guest Post

On April 8, 2025

In Animals, Anthropology, Biology, Environment/Sustainability, Field Research, Global Health, Guest Post

Forests and farmland meet in the SAVA region of northern Madagascar. New research suggests that wildlife-human interactions in such areas could spread disease. Credit: James Herrera, Duke Lemur Center

COVID-19 continues to plague us, Mpox is an emerging global threat, and the avian flu is decimating industrial poultry as well as endangered wildlife. What do all these epidemics have in common? They originated in wild animals and spread to domestic animals and people.

This pattern of spread is a trademark of many diseases, termed zoonoses or zoonotic diseases. Our new research shows that in rural settings of Madagascar where forested landscapes were converted to agriculture and settlements, the potential transmission of a deadly virus, Hantavirus, is likely facilitated by invasive rodents, especially the black rat. Also responsible for cyclically occurring plague events in Madagascar, the black rats could be transmitting multiple diseases to people in rural communities, based on our studies.

The work was published April 7 in the journal Ecology and Evolution.

*People can get Hantavirus from the droppings or urine of rodents like rats and mice*. *Credit: Wikimedia Commons*

Hantavirus is mainly spread from rodents to people via exposure to their urine and feces in the environment, and being bitten. It can cause severe and deadly disease of the lungs and kidneys, resulting in fever, fatigue, aches and pains, followed later by coughing, shortness of breath, and fluid in the lungs, causing death in almost 40% of people who experience later-stage symptoms. In rural settings like in Madagascar, there are no tests available to diagnose Hantavirus, and the generalized symptoms are often confused for influenza or other diseases. With no specific treatment, either, Hantavirus is an important, though neglected, zoonotic pathogen.

This research, funded by the U.S. National Institute of Health and National Science Foundation, as well as Duke University, connects scientists from around the world with diverse specialties, including field biology, infectious disease epidemiology, social sciences, veterinary health, and more. Over the last eight years, our international and interdisciplinary team studied zoonotic pathogens in wildlife, domestic animals, and people. We compare how pathogens vary among different animals and in different landscapes.

*Herrera and Malagasy student Tamby Ranaivoson check local mammals for pathogens.*

There are more than 29 species of small mammals and another 12 species of bats in these wildlife communities, including native rodents and animals that look like hedgehogs and shrews but are a unique group from Madagascar, the tenrecs. There are also ubiquitous introduced mammals, including black rats, the house mouse, and the shrew, which have spread around the world wherever almost everywhere people go. We studied natural, pristine rainforests and compared to different features of the agroecosystem including regenerating forests, agroforests, and rice fields. We captured rodents and shrews in people’s households, as well, to compare how small mammals and zoonotic pathogens change over this gradient of human land use.

Our results show that black rats were the only species in our system that were infected with Hantavirus, with 10% of sampled individuals infected. Rat abundance and infection were higher in agricultural settings, including rice fields and agroforests, where rats were larger. While some rats in people’s homes were infected, no infected individuals were found in the more mature forests. Hantavirus infection was lower in the homes than in the agricultural fields, but exposure to infected rats is likely higher in homes because of the close contact in enclosed settings. The results highlight how infectious disease risk varies across the landscape because of complex impacts of human land use on natural ecosystems.

The Hantavirus results closely mirror those our team have shown for other disease-causing emerging pathogens, including Astroviruses and Leptospira. Rats and the house mouse were the most commonly infected species, and in the case of Astrovirus, only a single individual of a native species was infected. While Astrovirus infection was more common in the regenerating scrubby environments, Leptospira infection was most common in seasonally flooded rice fields. These varying landscapes of disease risk have important implications for the emergence of zoonotic diseases as well as applications to policy for public health.

Preserving natural forest and facilitating the regeneration of transformed forests may decrease disease risk because infected individuals were rarely captured in natural forests. This may be because there are natural predators to keep rodent populations in check, though further research is needed. Calls to eradicate black rat populations have seldom been successful, but through nature-based solutions like restoration to encourage natural predators, it may be possible to decrease abundance of nuisance rodents. Awareness-raising campaigns to teach about the signs and symptoms of common rodent-borne diseases for rural communities will also be rolled out, and encouraging local health care workers to check for these symptoms in the community members they serve.

We share our results with the Ministry of Public Health and Ministry of Environment and Sustainable Development, and will be organizing more think-tank meetings with relevant actors to co-design intervention strategies that can address these potentially emerging threats to human well-being.

By James Herrera, Ph.D., Duke Lemur Center SAVA Conservation Initiative

Determining Who’s White: How Vague Racial Categories Mask Health Vulnerabilities

By Guest Post

On February 3, 2025

In Global Health, Medicine

Good healthcare decisions depend on good data – whether you’re making federal health policy or treating a single patient.

But the data is often incomplete – particularly when it comes to defining a group that still makes up the majority of the U.S. population — a ‘non-Hispanic White’ person. That’s the primary reference category used in health data.

“Nobody questions who’s white, but they should,” said Jen’nan Read, a Duke sociologist and lead author of new research recently published in the journal Demography. “The white category contains diverse ethnic subgroups, but because we lump them all together, we miss important health vulnerabilities for millions of Americans.”

Read and co-author Fatima Fairfax, a Duke doctoral student in sociology, analyzed data from the 2000 to 2018 waves of the National Health Interview Survey to compare the health of white adults born in the U.S., Europe, the Middle East, and the Former Soviet Union.

Duke sociology professor Jen’nan Read and PhD student Fatima Fairfax

Separating groups collapsed into the white category, they found that foreign-born Whites have a smaller health advantage over U.S.-born whites than is commonly assumed, and immigrants from the Former Soviet Union are particularly disadvantaged. Those immigrants report worse health, including higher rates of high blood pressure, compared to U.S.-born whites as well as people from Europe and the Middle East.

These findings illustrate how global events, such as the wars in the Ukraine and Syria, have contributed to changes in the composition of white immigrants over time.

Understanding these changes – and the distinct experiences of white immigrant subgroups – is vital to understanding long-term patterns in health disparities within the broad white category, the authors argue.

“If we truly care about reducing health disparities in this country, we need to know where the disparities are. And they get hidden when people are lumped into broad categories,” Read said. “Ukrainian immigrants, for example, we see in the news what they’re leaving. Death, destruction, their kids may have gone years now without education. This has lifelong impacts on their wellbeing. The physical consequences from stress are enormous–we know stress increases all sorts of physical health problems. High blood pressure, cholesterol, the list goes on.”

And the science is clear. The more accurate the information healthcare providers have on their patients, the better the outcomes.

“We’re missing health patterns here,” Read said. “Our country is extremely diverse, and not talking about diversity doesn’t change that fact. Health inequality costs us a lot–it costs the healthcare system and society as a whole.”

“Health is arguably the most important indicator of how a society is doing, and paying more attention to diversity within broad categories will allow us to do better.”

This Entrepreneur Is Changing the Way We Repair the Human Body

By Sarah Pusser

On January 28, 2025

In Biology, Biomedical Engineering, Business/Economics, Data, Engineering, Genetics/Genomics, Global Health

A long time ago in a galaxy far, far away… Or should I say, January 23 at the Rubenstein Arts Center…? That is where biomedical engineer Nina Tandon showed us the almost magical, yet extremely precise, science of EpiBone–where personalized bones and cartilage are grown from stem cells.

But first, it would be completely inappropriate of me to discuss Tandon’s revolutionary work without first sharing her stories from her childhood and adolescent years; that was one of the many aspects I admired about her talk–how much love Tandon shared for those who helped spark her passion for science.

First, there was her grandmother, Dadi Ma, who at a young age wanted to study math, but unfortunately, due to the time she grew up in, was pushed away from any STEM-related field. Tandon helped complete her Dadi Ma’s dreams to pursue a STEM education. And there were the late nights in the research library with her mother; Tandon told us how she would often use her class as a group to “test how people’s memories worked, and test our (Tandon’s) classmate’s depth perception.” Then, Tandon met Dr. Maria Musarella, who helped identify her brother’s retinitis pigmentosa. And while no cure for it at the time, Dr. Musareli told Tandon how there was a team at MIT working on it–to which Tandon thought, “Maybe I’ll join that team one day.”

Little did young Nina Tandon know just what she would do one day.

After going to school for electrical engineering, Tandon found herself working at a Bell Labs spin-off, where she learned one of the most important lessons of her life: One’s choice of job should always be “content secondary, people primary.” However, because of the new suburban area she found herself in post-9/11, Tandon felt isolated. But within this time of solace, she was able to connect the similarities between genes and data: “The axon conduction in a nerve–that’s a lot like those same equations that govern the transatlantic cable… cell membranes are 20 times higher capacitance than the best capacitors that we could build with our human hands.”

Through these observations, Tandon was able to conclude that “our bodies are the most exquisite technology we have ever been familiarized with.”

Photo credit: London College of Osteopathy

So she decided to apply to the team at MIT that Dr. Musarella had told her about years before, in which she was accepted and then joined. It was a full circle moment; Tandon was seeing herself living the dreams of the girl who would conduct experiments on her elementary school class. It should have been perfect, right?

“And I had made a mistake… I made a mistake.” She had not chosen people first and content secondary. However, as Tandon noted many times throughout her talk, it is her failures that showed her what it was she needed to do in order to succeed.

I found this aspect of the talk truly inspiring. Usually, when an extremely accomplished person talks to an eager room, they spend most of their time highlighting what they have done correctly. But here Tandon was, taking her time telling us all of the ways in which she had failed. And how those were the moments that led to her largest lessons learned. Although I can’t speak for everyone in that room, as a college student myself, there was a comfort in seeing such a successful, powerful, and kind woman telling us that we will fail… And showing us that that is the beauty in success.

So, to make an extremely long story short, Tandon then proceeded to join Robert Langer’s lab at MIT for five years, studying “how electrical signals could coax stem cells into becoming tissue,” work in a management consulting job at McKinsey & Company to learn more about entrepreneurship, and then attend Columbia for her EMBA and PhD (at the same time!). Phew, that’s a lot.

In 2014, Tandon co-founded EpiBone, in which she and her team began working in a candy factory-converted lab in Harlem. By starting with CT scans, EpiBone can make a “perfect puzzle piece-shaped biome material scaffold and a perfect puzzle piece bioreactor.” In other words, “an environment that simulated the natural conditions for tissue development.” Within two to four weeks, Tandon and her team can grow any cartilage, bone, and joints needed throughout the body.

Since starting her company, EpiBone has been able to grow jaw bones for six patients, which “fit perfectly and were integrated within four to six months.” This is just the beginning. EpiBone’s technology could change how we view medicine and treatment–giving patients a promise of more active lives instead of just a prescription of pain medicines.

However, as much of a miracle as this is, Tandon had to move her business’s location because of the restraining process of clinical trials within the United States, where the limited funding cannot match the necessary costs of clinical trials. Now in Abu Dhabi, Tandon has found a home for her and her family to live happily while also being in a place where she feels like EpiBone is finally starting to see a future where it can be implemented into medicine and used in patients.

Ending her talk, Tandon noted how she has learned to count her blessings, even in times when she felt like her work was not being appreciated for what it was. “It’s a shortcut for me because I’ve studied biology to be grateful… Oh my god, my heart just beat five times–that’s like a million miracles.”

Tandon has shown us that true success is not viewed from the top of the mountain, looking down at all that you have climbed, but instead, learning to appreciate and find joy in the trek to the top. I thank her, on behalf of all of the people at Duke and all who she will help in the future, for her revolutionary work in science and her honest words of inspiration.

By Sarah Pusser Class of 2028

Climate of Care: Addressing the Health Impacts of Climate Change

By Gabrielle Douglas

On November 15, 2024

In Climate/Global Change, Global Health, Medicine

In an increasingly polarizing world, the discussion surrounding human rights remains at the forefront of all that we do as a society. People are becoming more aware, as, these days, violations are displayed right before our eyes. With a click of a button or a swipe of the thumb, people are able to see travesties occurring throughout all parts of the world. Developments in technology help us remain knowledgeable about such issues, but what about the offenses that we don’t see—the silent killers that we chalk up to poor fate, to chance? What about the violations in which we ourselves play a major role? These are urgent questions that researchers at the Duke School of Medicine are working to answer, with a specific focus on the deadly impacts of climate change.

In times of crisis, the most disadvantaged communities bear the greatest burden. The researchers recognize that climate change is no different and have strategized ways to reverse these effects. They presented their research in a recent talk, titled Climate Change and Human Health: Creating a Strategic Plan for Duke’s School of Medicine. Associate Professor and lung disease expert Dr. Robert Tighe led the conversation.

*A photo of Dr. Robert Tighe. Courtesy of Duke’s Department of Medicine Website.*

While presenting his research, Tighe identified a major shift in sea surface temperature trends, noting that the trend has deviated greatly from the statistical norm. Although the reasons behind this shift are not fully understood, it is believed to have serious implications, as excess heat poses risks to human health. According to the Centers for Disease Control, increasing temperatures and carbon dioxide have the potential to impact water quality, air pollution, allergens, and severe weather conditions. These conditions, in turn, bring forth respiratory allergies, cholera, malnutrition, and cardiovascular disease, to name a few. Tighe’s research goes beyond the general effects of these issues; it delves into how they disproportionately impact the most vulnerable members of society: children, the elderly, low-income communities, and communities of color.

*A chart containing information about the most vulnerable parts of population to the effects of climate change. Courtesy of Biological Science.*

On a local scale, Tighe highlights that many in these vulnerable positions often lack access to the healthcare necessary to mitigate these impacts. For instance, low-income citizens are often unable to afford the costs associated with repairing the physical damage climate change inflicts on their homes, leaving them exposed to pollutants and the effects of environmental toxins. The elderly also find themselves in similarly precarious scenarios, as many of these situations require evacuation—something not always feasible for those in fragile health. Consequently, they too are left exposed to pollutants and dietary challenges exacerbated by climate change.

On a global scale, these issues heavily impact countries in vulnerable positions. The United States, China, India, the European Union, and Russia are among the largest contributors to carbon emissions. However, the consequences of this burden fall disproportionately on countries like Bangladesh, Haiti, Mozambique, small island nations, and others. Due to their geographic locations, climate change brings far more than just hotter days—it brings devastating hurricanes, tsunamis, cyclones, and widespread malnutrition. The limited financial resources in these nations make rebuilding and mitigating these impacts extraordinarily challenging, especially as many climate effects are recurring. This disparity is particularly frustrating, as these countries contribute only a fraction of the world’s carbon emissions.

*A map of the global climate risks. Courtesy of the New York Times.*

This is precisely what Tighe’s work aims to address. He is working to connect the science on climate change effects, researched by those in the School of Medicine, with that of the Nicholas School of the Environment. Referring to this as an interdisciplinary issue, Tighe believes that the place to begin is within the community. He emphasizes the importance of starting with the people of Durham: What do they need? How can we best help them? How does this affect our own backyard? He stresses the importance of outreach, educating the community on how climate has long-term impacts on their health. Tighe also underscores the need to view this as an opportunity to combine diverse strengths to address the crisis from every angle.

In the face of a climate crisis that goes beyond borders and affects the most vulnerable among us, Tighe’s and his fellow researchers’ work is a call to action. By fostering collaboration between scientific fields and engaging directly with local communities, he develops an approach that is both comprehensive and compassionate. His work reminds us that addressing climate change isn’t just a scientific or political issue—it’s a deeply human one, demanding a united effort for the wellbeing of all under the sun.

Post by Gabrielle Douglas, Class of 2027

From Immune Responses to Private Equity, New Series Offers “Research On Tap”

By Crystal Han

On October 28, 2024

In Biology, Business/Economics, Entrepreneurship, Global Health, Immunology

On every third Thursday of the month, Devil’s Krafthouse is host to Research on Tap: a series that gives Duke researchers, from undergraduates to postdoctoral fellows, the opportunity to present their work in a casual setting. It may seem odd for the procedures of academia to make their way into a space for socialization and entertainment, but this situation allows individuals to practice speaking publicly to a general audience under a short time limit–good conditions for developing their “research elevator pitch.” These were the pitches on October 17:

*As it’s name suggests, Cv is a bacterium violet in color. Photo courtesy of Dr. Edward Miao and Dr. Carissa Harvest.*

Jacqueline Trujillo, a Ph.D. student in the Department of Molecular Genetics and Microbiology, who is part of Dr. Edward Miao’s lab, presented her research on immune cell response to the bacterium Chromobacterium violaceum (Cv). Being an environmental pathogen, Cv usually resides in the soil of tropical and subtropical areas. While disease in humans is rare, the mortality rate is high in immunocompromised individuals.

“The Miao Lab was initially studying pyroptosis, a form of cell death that occurs during infection, when they discovered Cv-induced granulomas,” Trujillo said. Granulomas are specialized structures that are formed to contain and eradicate pathogens, but they can range in the arrangement and type of cells they consist of; one induced by tuberculosis infection, for example, would include adaptive immune cells like T and B cells. However, when the pathogen inducing them is Cv, only innate immune cells are present: neutrophils in the inner cluster and inflammatory macrophages in the outer cluster. When Cv is detected, neutrophils are the first to flock to the site of infection in a “toxic swarm.” The neutrophils themselves are typically able to effectively kill microbes even before granuloma formation. “These are one of the most toxic defending cell types in the immune system,” Trujillo said.

Despite this, the lab observed something unusual: these neutrophils failed to kill off the Cv bacteria, which continued to replicate despite the swarm. The lab ultimately saw Cv eliminated by the innate granulomas within about 21 days, but the ability to survive the neutrophils is what Trujillo now aims to understand. Such a feat from an environmental bacterium comes as a surprise, being “something more characteristic of the causative agent [Yersinia] of the bubonic plague,” Trujillo said. A comparison between the proteins CopH and YopH, virulence effectors in Cv and Yersinia respectively, reveals lots of similarities between the two. Trujillo hypothesizes that CopH is part of the secret to how Cv disarms the immune system’s defenses.

The role of virulence effectors is generally “aid[ing] in survival, invasion, and suppressing immune responses.” Through needle-like structures, bacteria inject these proteins into a host cell. A cell responds to this in two main ways. It dies–initiating pyroptosis to prevent the pathogen from replicating inside the cell. Second, it signals for help by making chemical messengers called inflammatory cytokines. Investigating the first response is what led the Miao Lab to Cv-induced granulomas.

Now, the lab is interested in understanding the regulatory signals that form the granuloma–and the role that inflammatory cytokines might play, if any. In addition to testing her hypothesis on CopH, Trujillo intends to determine if neutrophils respond to Cv’s initial survival by producing the cytokine IL-18, thus recruiting immune cells to the infection site. This would help the Miao Lab confirm their idea that the neutrophils’ failure to clear Cv is what prompts the process of granuloma formation.

With much still unknown in the area of granuloma biology, Cv provides an “excellent model for studying immune cell biology and characterizing bacterial virulence effectors,” Trujillo said.

Though it happens that many Research On Tap speakers are in the sciences, the program isn’t discipline-specific. Our second researcher of the evening, Sungil Kim, studies a far different field from Jacqueline.

As a Ph.D. student in Finance at the Fuqua School of Business, Kim is looking at the effects of a growing trend in recent years: private equity (PE) firms acquiring healthcare companies. His focus is on what’s known as the “buy-and-build”, as this business strategy is often used by such firms entering the healthcare sector. The scenario typically looks like this: a private equity firm first acquires a large existing company, called the platform company or “first deal.” They’ll then acquire several smaller companies, or “add-on deals,” in order to expand the platform company’s operations.

Since private equity firms buy businesses with the eventual goal of selling them at a profit, their primary focus is increasing efficiency to reduce costs. On one hand, these buyouts might be seen as beneficial for languishing businesses in need of operation enhancements. But within the healthcare sector, many worry the resultant cost-cutting will lead to declining standards of care for patients.

Kim set out to investigate if operational improvements are sustainable across multiple acquisitions within the buy-and-build framework. The simple answer? No.

Kim confirmed that, on average, private equity firms improve the operational performance of hospitals without hurting quality, “a finding that agrees with some of the previous literature.” Yet, one only needs to take a closer look into the sequence of deals to uncover a different, more complicated story.

To arrive at his answer, Kim considered three main factors–operational efficiency, profitability and quality–in both the platform company and add-on companies. Platforms, or first acquisitions, did see success in performance, but this came with what appears to be a trade-off, as the first two factors increased while quality went down. As in, quality of healthcare. From one of Kim’s graphs, it was apparent that occurrences of four of the six health outcomes measured, including mortality and remission of heart failure, increased in such first deal situations.

Meanwhile, results for the add-ons changed little before and after the buyout, meaning that the initial success from the platform didn’t carry over to later acquisitions, even as reduced costs did. A potential reason for this inability to replicate success, Kim explained, is that these cost savings may come from reducing the number of patients and services, instead of truly improving the efficiency of operations.

In contrast to academic journals that display research that’s been in the works for years, Research on Tap brings us closer to working papers in their ongoing, exploratory stages. While it’s difficult to draw wider conclusions from Kim’s findings just yet, and important to remember the specific first deal context of this study, research like his helps us further understand the issues facing improvement of our healthcare system and where private equity plays a role.

If you’re interested in learning something new and free Krafthouse bites, swing by and attend a session–the next one occurs on November 21, 2024 at 5 p.m. The program welcomes prospective speakers to place themselves on the waitlist for a spot.

40 Years in Global Health – an Interview With Dr. John Bartlett

By Stone Yan

On October 21, 2024

In Global Health, Immunology, Medicine

Dr. John Bartlett, Professor of Medicine and Global Health Researcher

In your retirement, would you ever hold four Zoom calls every week with colleagues?

To be fair, Dr. John Bartlett is not technically retired. He is employed by Duke at the 20% level and continues to serve as a Professor of Medicine. However, his busy schedule, which also includes 2-3 months in Tanzania every year and writing grants to support research education efforts, in no way resembles the glorified picture of retirement many of us imagine!

Fellow freshmen, we may be in for the long haul.

Before I dive into my interview with Dr. Bartlett, I must acknowledge the incredible enthusiasm he showed in response to my invitation to an interview. Even as cable lines are down in western North Carolina, where he resides, due to the impact of Hurricane Helene, he still offered to keep our original interview time and made himself fully accessible to my questions. I extend my sincere gratitude to Dr. Bartlett for his time, and it is only just for me to relay his thoughts to our readers at large.

For students unfamiliar with Dr. Bartlett’s background or professional experiences, he has been a Duke faculty member since the 1980s, serving as both a physician in infectious diseases and internal medicine and a professor. His lengthy career traversed continents, having become deeply involved in international HIV/AIDS research and treatment since the 2000 World AIDS conference held in Durban, South Africa.

“As I traveled to South Africa, I witnessed the profound disparities between clinical outcomes for patients in the U.S., who were thriving, and [those in] the continent most severely impacted by HIV, where no treatment was available,” said Dr. Bartlett, recalling his transition to international work. “We reckoned that [the] concept of research with service could be applicable with an African partner,” he added, which led him to spend two-thirds of the next decade in Tanzania, focusing on this new partnership.

Picture of the Kilimanjaro Christian Medical Centre, where Dr. Bartlett conducted most of his research and education efforts in Tanzania

Captivated by Dr. Bartlett’s unique experiences, I inquired why he became involved in Tanzania, a country halfway across the globe. To my surprise, it turned out that in the early 2000s, faculty and students at Duke held a strong inclination towards advancing global health research. At the same time, researchers also sought to expand the scope of their activities overseas. Dr. Bartlett shared what was perhaps the most important reason last: “I have to credit my wife, a social worker, who was also quite committed to international work.”

I learned much about global health throughout the interview. When Dr. Bartlett shared statistics showing 100% effectiveness of certain HIV/AIDS treatments currently offered in lower-income countries, I was stunned. From no access to treatment a few decades ago to successful management of the disease today, there has been remarkable and swift progress that is saving millions of lives. Of course, there are still barriers to treatment including cultural norms, “ubiquitous” stigma, lack of testing resources, and cost. However, the global health field is advancing every day, with newfound knowledge regarding protective factors against HIV transmission helping to further lower mortality rates.

Discussing Duke’s global health efforts at large, Dr. Barlett was quick to point out the diversity of current projects around the world. “I would refer you to the website for the latest list of countries because I can’t keep up with the continuing growth!” Upon a quick search, this sentiment makes sense: Duke works in more than 40 countries and there are more than 100 active projects. “I am especially proud to see that [the institute’s work] is not limited to a single geographic region or a single topic”, Dr. Bartlett added, reflecting how projects “run the gammit from infectious diseases to non-communicable diseases to cancer to mental health to health systems strengthening.”

By this point in the article, maybe some engineer readers are yearning for a message pertaining to their academic interests. Don’t worry, Dr. Bartlett talked about your importance in global health work during the conversation too! “There are quite a few BME professors who work with students to develop practical, low-cost solutions to common global health problems,” he said. From rapid diagnostic tests to laparoscopes, the BME department has played a crucial role in the Global Health Institute’s efforts. And these engineering projects are still active: for students desiring to involve themselves in this work, Dr. Bartlett recommends reaching out to Dr. Ann Saterbak, a Biomedical Engineering professor who coordinates many opportunities.

Before I conclude, I would like to share a quote from Dr. Kathy Andolsek, professor of family medicine, discussing the character, expertise, and work of Dr. Bartlett:

“He was a dedicated researcher and clinician and an early pioneer in HIV/AIDS. [As a] primary doc, I [worked] with him to get my patients into his clinical trials… so we ‘shared’ many patients. He was inspirational to students and a great listener.”

Thank you, Dr. Bartlett, for your tireless work on HIV/AIDS treatment around the world. As an educator, researcher, and clinician, you have contributed much to the betterment of health outcomes for patients. Your commitment towards this noble cause and desire to help Tanzanian counterparts become independent in their research encourage all of us, medical students and non-medical students alike, to persistently pursue goals we believe in.

Senior Presenters Explore Cultural Dynamics and Justice Around the World

By Noor Nazir

On May 3, 2024

In Anthropology, Field Research, Global Health, Students

When we think about global interconnectedness we often focus on varied cultures, but we tend to forget about innumerable systemic dynamics that could enrich our understanding of the world. The senior presentations given by students in International Comparative Studies to mark the end of the term shared their mission to understand the world better through research.

The exploration of language ideologies in Mauritius, the complex yet fascinating web of transitional justice, the contentious aspects of medical missions in global health, and the intersection between superficiality and urban dynamics in Los Angeles all demonstrated understanding the unseen world at play.

Language and Identity in Mauritius

Katy Turner’s research into the Mauritian education system sheds light on the complex interplay between language and colonial histories. Even though one could argue colonialism is a tale of the past, Turner’s research proved otherwise. In Mauritius, where the creole language — formed by enslaved individuals and now a mother tongue — meets societal resistance, the educational emphasis remains on English and French. Turner’s exploration raises critical questions: How do Mauritian primary school teachers perceive the role of Mauritian Creole, especially given its contentious status? How has the colonial past shaped these perceptions?

Her findings reveal a conflicted landscape. While some view the Mauritian Creole as a relic of the past, advocating for a future aligned with English, others see it as vital for a holistic educational experience. Its colloquial use in classrooms helps connect students with their history, and according to her observation, students didn’t mind its use over English and French, but their parents very much did. They preferred English and French over their own local language. This put me in a daze. Afterall, being Pakistani born and raised, this wasn’t a surprise: English is the language of the rich, and Urdu is the language of the poor. These complex linguistic preferences of these countries highlight how colonized some developing countries are till today.

In Mauritius, the narratives of slaves, parents and educational policies often discourage this practice. This ‘hidden curriculum‘ suggests a deep-seated struggle with identity and linguistic heritage, hinting at a broader dialogue about language as a carrier of culture and history. This colonial hangover is one we need to fight to connect with what our culture really means.

The Anti-Politics of Memory in Transitional Justice

Grace Endrud delves into the “anti-politics” of memory, examining how transitional justice often morphs into a universal narrative that may overlook local truths. Her focus on the International Center for Transitional Justice (ICTJ) illuminates the challenges of defining justice in varied contexts — ranging from criminal justice to truth commissions. The ICTJ’s extensive work is reflected in their archival collections spanning several decades. Grace sat in the library searching through archives for days, and went to great lengths (like analyzing the order they were in) to show their global influence also reveals tensions, such as in Iraq where document manipulation was used to sway electoral outcomes.

Blindfolded suspected militants, with possible links to al-Qaeda, are seen at Iraqi police headquarters in Diyala province, north of Baghdad December 5, 2011. Police forces arrested 30 suspected militants during a raid in Diyala province, a police source said. REUTERS/Stringer

This research was inspired by James Ferguson’s analysis in “The Anti-Politics Machine.” It suggested that transitional justice can sometimes strip away the political layers that are essential for understanding and addressing the root causes of injustice.

Reassessing Medical Missions Through a Decolonial Lens

Catherine Purnell’s investigation into medical missions driven by evangelical Christian beliefs poses questions about the possibility of decolonizing global health. The narrative that divides the world into those who help and those who need help is deeply entrenched in the ethos of many medical missions. Purnell’s interviews with medical missionaries reveal an underlying intention to provide care in remote areas, which often includes building schools and water systems alongside healthcare.

However, the real challenge lies in shifting these missions from a model of evangelical humanitarianism to one of genuine decolonization. According to her, true decolonized care would prioritize giving autonomy back to local communities and focusing on solidarity rather than charity. Purnell’s findings suggest a fundamental conflict between the traditional goals of medical missions and the emerging needs of decolonial, equitable healthcare practices.

The Multicultural Dynamics of Urban Spaces

Jess Blumenthal’s exploration into the complex narratives of multiculturalism in Los Angeles offers a fascinating lens through which to view urban dynamics and identity. Starting with the historic intersections in neighborhoods like Little Tokyo/Bronzeville, Jess examines the fluid and often contentious shifts in community compositions and their cultural implications. Originally a Japanese neighborhood, Bronzeville became predominantly African American during World War II when Japanese residents were interned. Such shifts underscore the impermanence and adaptability of urban ethnic landscapes.

Jess connects these historical and cultural narratives to broader literary works like “Tropic of Orange” and Octavia Butler’s “Parable of the Sower.” These works critique the superficiality of multiculturalism, suggesting a more interconnected and deeply woven fabric of society that transcends simplistic understandings of diversity. Jess uses these stories to highlight a poignant metaphor: just as characters in Butler’s work envision a destiny among the stars, our own societal evolution might be seen as an ongoing journey towards a more genuinely integrated multiculturalism.

Conclusion

Together, these presentations accentuated the complexities of cultural identity, memory politics, and health equity in a globalized world. They challenge us to think critically about how languages shape national identity, how justice processes can reflect deeper truths without falling into the traps of depoliticization, and how global health initiatives might genuinely respect and uplift the communities they intend to serve. As our world becomes increasingly interconnected, these discussions are crucial for fostering a more just and equitable global society.

Big Bets on Humanity: How Rajiv Shah’s Audacity is Winning the Fight Against Pandemics

By Noor Nazir

On March 30, 2024

In Global Health, Lecture

If your community relied on COVID-19 rapid tests to reopen safely during the first year of the pandemic, there’s a good chance Rajiv Shah had something to do with it. Not just for his ambition but also for his audacity to transform the nature of our response to pandemics: Rajiv Shah, the president of the Rockefeller Foundation, played a crucial role in scaling up diagnostic testing for COVID-19.

He’s also the man who tackled Ebola with the Obama Administration. Back then, Shah and his team embarked on a “big bet” to deploy 2,500 troops to fight the disease, not on the battlefield, but on the frontlines of human health. Much like the name of his 2023 book “Big Bets,” he embarked on a journey to change the world.

In a Jan. 31 talk hosted by the Duke Global Health Institute, Shah discussed his “big bet mindset” when it comes to tackling public health challenges.

Bet #1 Diagnostic Testing at Scale

For starters, what’s a big bet?

“It’s a big bet you take on the community to help young people get opportunities. Often, when we think of charitable endeavors, we imagine that doing a little bit is beneficial because it makes us feel good. In contrast, a big endeavor means taking on something significant and engaging in the hard work necessary. It’s about going beyond just doing the best we can; this isn’t merely a charitable endeavor, it’s a strategic approach to ensure national security.” Shah explained.

Keeping true to his word, the goal was clear: administer 30 million tests per week to preempt the need for lockdowns and enable a safer, faster return to normalcy. This was not just a health initiative; it was a socio-economic strategy aimed at averting total disaster. He took a big bet, and the numbers spoke for themselves. The Rockefeller Foundation played a pivotal role in assisting schools with their reopening strategies during the pandemic. This support included the establishment of collaborative networks, the development of resources and guidelines, and the provision of expert recommendations. Now do you get why this man probably saved your life? It’s because he did!

Bet #2 A Memo for Bill Gates

It wasn’t all that easy for him though. He had his haters (don’t we all?). Perhaps the difference was, his hater was Bill Gates. But he successfully proved Gates wrong too. Thankfully, Gates and Shah are more like besties than anything now. Despite the initial dismissal of his ideas as “the stupidest thing,” Shah’s persistence and innovative thinking paved the way for a groundbreaking bond structure to fund vaccinations, ultimately saving millions of children’s lives. Shah and Gates – two greats in one room – inevitability led to the production of something good: The Vaccine Alliance. This meeting set the stage for a three-year roadmap focused on a bond structure to fund vaccinations. This initiative ultimately contributed to saving 16 million children’s lives.

The Final Bet: The Power of Experimentation.

I’ll be honest, I was intimidated walking into this room. I was in my Duke hoodie, not expecting fancy foods, and coat checks (good news: this meant they recorded his speech and uploaded it on YouTube. Check it out!).

At the heart of Shah’s philosophy is a belief in the power of experimentation and innovation. His call to “keep experimenting” embodies the spirit of resilience and creativity that is essential for tackling the world’s most daunting health challenges. Being amidst well-suited individuals while donned in a hoodie wasn’t an experiment in the scientific sense, but it was an experience that highlighted the contrast between expectations and reality, comfort zones and the unfamiliar. It served as a metaphor for the broader experiments we’re all a part of—those that push us beyond our boundaries, challenge our preconceptions, and ultimately lead to growth.

His book was called ‘Big Bets’ because the editors thought it was catchy. They were right. But this title doesn’t just grab our attention—it invites us into a world where daring to dream big and taking calculated risks can lead to monumental changes in public health and beyond.

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