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

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How Art Reflected Child Mortality in the 20th Century

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How does parenting change when infant and child mortality affects every family in society? Recent history may provide an answer. For the entirety of the 19th Century, child mortality was ubiquitous. In the year 1880, nearly 35% of children born in the United States passed away in their first five years. The medical literature that explores the common diseases and public health inadequacies, though expansive, often fails to address the central humanistic questions surrounding such widespread death. How were these children mourned? How did grieving families move on? And how has this mourning changed in the context of the past hundred years of medical advancement?

These guiding questions drove Dr. Perri Klass, Professor of Journalism and Pediatrics at NYU, to pen her recently published book, “The Best Medicine: How Science and Public Health Gave Children a Future.” A distinguished clinician, author, and medical historian, Klass explored prominent art and literary works from this era of high infant and child mortality at the recent Trent Humanities in Medicine Lecture at the Duke School of Medicine, titled “One Vacant Chair: Remembering Children”.

Dr. Perri Klass, MD

Throughout the lecture, Klass guided the audience through famous portraits, poems, and prose produced in the 18th Century that memorialized children who had died at a young age. Perhaps the most famous fictional account of childhood death in the 19th century emerged in Uncle Tom’s Cabin by Harriet Beecher Stowe. The emotionally wrenching death scene of young Eva, who succumbed to tuberculosis, struck a chord with virtually all those who read the novel. Published in 1852, Uncle Tom’s Cabin would go on to be reproduced in theaters across the country for several decades, the death scene becoming a ubiquitous anchor that often brought the audience to tears. Klass further described how Beecher Stowe drew from her personal experience, the death of her son Charlie from cholera only a few years prior to the writing of the book, to create this powerful literary scene.

“Uncle Tom’s Cabin.” Published in 1852 by Harriet Beecher Stowe.

Beecher Stowe was not the only author whose personal experience impacted their art. Charles Dickens, deeply impacted by the death of his children, had created a slew of sentimental yet mortal child characters in his stories. One of the most prominent examples, young Nell from “The Old Curiosity Shop,” was published in installments and developed a strong following. Dickens ended the series with the death of twelve-year old Nell, much to the outrage of international readers.

Perhaps it’s no surprise that parents chose to memorialize their deceased children through literature and art. Wealthy families would often contract famous portrait artists were often contracted to depict their dead children. Some, including the Rockefellers and the Stanfords, channeled the deaths of their children and grandchildren into resourced academic institutions.

For grief to drive philanthropy and art is not a new phenomenon, but the sources of grief that drive such artistic and financial overtures today have changed considerably. Klass sought to bridge this knowledge gap and pull closer the history to which society has the privilege of being oblivious. Maybe, even, it would even inform how we cope with the mortality of young people today.

“How do we situate ourselves in a world where infant and child mortality is so low?” Klass asked at the beginning of her presentation.

The past does not reveal one clear answer, but it does provide a tapestry of options, many lost in our modern collective memory, for mourning, for celebrating, and for memorializing.

Post by Vibhav Nandagiri, Class of 2025

Duke Alum Dr. Quinn Wang on Medicine, a Healthcare Startup, and the Senior Thesis That Started it All

As a senior at Duke University in 2010, Dr. Quinn Wang was simply Quinn, an undergraduate English major on the pre-med track, wondering how to combine her love for medicine with her love for English. This is how her senior thesis was conceived – Through the Lens of Medicine: Landscapes of Violence in Cormac McCarthy’s Blood Meridian (1985), All the Pretty Horses (1992), and No Country for Old Men (2005) – which ended up winning the English department’s award for “Most Original Honors Thesis.”

Dr. Quinn Wang

Fast forward 12 years, and Wang can now call herself a double Dukie, having completed medical school here. She went on to complete ophthalmology residency at UCSF and this past Saturday, November 5, came back to her alma mater as part of the Duke Medical Ethics Journal’s Medicine, Humanities, and Business celebration to talk to an eager audience at Schiciano Auditorium about her path from Duke until now.  

She began her story during the infamous year of 2020, when she was forced to stop seeing patients at her private practice in California’s Bay Area due to COVID-19. Restless and anxious about how her patients were doing, she tried to keep up with them as best she could, but of course there were limitations. And then, a few months in, one of her patients went blind.

This tragic moment sparked a frustrating realization by Wang that in the tech capital of the world – San Francisco – there was still no good way to test people’s eyesight from home to prevent what should have been preventable. She decided to put together something herself, guided by the one question she thought was most important to answer until COVID-19 abated and people could come into clinics again – “how do we make sure people don’t go blind?”

Wang took common visual eye-testing tools used in clinics, and with some simple Photoshop editing and a little bit of code, turned them into a series of easy multiple-choice questions that could be answered from home. This simple but powerful transformation turned into Quadrant Eye, a start-up she co-founded with software engineer Kristine Hara.

A common visual tool used to test eyesight is the Snellen chart

The Quadrant Eye journey has taken her from running a private practice as an ophthalmologist to taking the plunge into business by applying to and getting selected for Y Combinator, which calls itself a “graduate school for startups”. YC invests $500,000 into a selection of early-stage startups twice a year. Then, for three intense months, they provide support to get startups off the ground and in good shape to present to investors for funding. At YC, Hara worked on turning Quadrant Eye into an app, and Wang renewed hundreds of prescriptions.

Quadrant Eye

Ultimately, though, the most significant place Quadrant Eye has led Wang to is a journey of self-mastery that applies to any human endeavor, from building a startup to doing research to just getting up every morning.  As she describes, startup life entails always learning new things and always messing up – which, for someone who professes that “I don’t like to do things I’m not good at” – can be challenging. She candidly admitted that she, like everyone, has bad days, when sometimes all she can do is throw in the towel and end work early. “I have more doubts than I care to admit,” Wang says, but at the end of the day, “we’re all climbing our own mountains”. Pushing through requires “superhuman effort” but it’s worth it.

And as for that English thesis? Wang describes how Quadrant Eye’s very first investor – “let’s call him Charlie” – asked her all the requisite questions investors ask early-stage startups (think Shark Tank). But he also asked her for something non-traditional – all fifty or so pages of her undergraduate honors thesis she had written ten years back. Apparently, he had seen a mention of it on LinkedIn and was intrigued. A few weeks later, Wang received a phone call that he was interested in investing – and he admitted that her thesis had played a part. To him, the uniqueness and quality of her thesis showed that Wang could problem-solve, communicate well, and think creatively, and Wang herself agrees. “My English thesis showed me that I can do hard things,” she said, and if Quadrant Eye is any indication, clearly, she can.

Post by Meghna Datta, Class of 2023

Insights on Health Policy Research from Undergraduate Cynthia Dong

“After COVID-19,” senior Cynthia Dong (T’23) remarks, “so much of what was wrong with the medical system became visible.”

Duke undergraduate Cynthia Dong, Class of 2023

This realization sparked an interest in how health policy could be used to shape health outcomes. Dong, who is pursuing a self-designed Program II major in Health Disparities: Causes and Policy Solutions, is a Margolis Scholar in Health Policy and Management. Her main research focus is telehealth and inequitable access to healthcare. Her team looks at patient experiences with telehealth, and where user experience can be improved. In fact, she’s now doing her thesis as an offshoot of this work, researching how telehealth can be used to increase access to healthcare for postpartum depression.

Presenting research on telehealth

In addition to her health policy work, however, Dong also works as a research assistant in the neurobiology lab of Dr. Anne West, and her particular focus is on the transcription mechanism of the protein BDNF, or brain-derived neurotrophic factor.

While lab research can be clearly visualized by most people (think pipettes, rows of benches littered with bottles and plastic tubes, blue rubber gloves everywhere), health policy research is perhaps a little more abstract. When asked what the process of research through Margolis is like, Dong says that “it’s not team-based or individual – it’s a lot of both.” This looks like individual research on specific topics, talking to different stakeholder groups and people with certain expertise, and then convening for weekly team meetings.

With other Margolis Scholars

For Dong, research has been invaluable in teaching her to apply knowledge to something tangible. Doing that, you’re often “forced to understand that not everything is in my control.” But on the flip side, research can also be frustrating for her because so much of it is uncertain. “Will your paper get published? Is what you’re doing relevant to the research community? Will people invest in you?”

In that vein, research has humbled her a lot. “What it means to try to solve a societal problem is that it’s not always easy, you have to break it down into chunks, and even those chunks can be hard to solve.”

After graduation, Dong plans on taking a couple of gap years to be with family and scribe before ultimately pursuing an MD-MPH. Because research can be such a long, arduous process, she says that “It took me a long time to realize that the work we do matters.” In the future, though, she anticipates that her research through Margolis will directly inform her MPH studies, and that “with the skills I’ve learned, I can help create good policy that can address the issues at hand.”

An Interview With Undergraduate Researchers and Labmates Deney Li and Amber Fu (T’23)

What brings seniors Deney Li and Amber Fu together? Aside from a penchant for photoshoots (keep scrolling) and neurobiology, both of them are student research assistants at the lab of Dr. Andrew West, which is researching the mechanisms underlying Parkinson’s in order to develop therapeutics to block disease progression. Ahead lie insights on their lab work, their lab camaraderie, and even some wisdom on life.

(Interview edited for clarity. Author notes in italics.)

What are you guys studying here at Duke? What brought you to the West lab?

DL:  I am a biology and psychology double major, with a pharmacology concentration. I started working at a lab spring semester of freshman year that focused on microbial and environmental science, but that made me realize that microbiology wasn’t really for me. I’ve always known I wanted to try something in pharmaceutics and translational medicine, so I transitioned to a new lab in the middle of COVID, which was the West lab. The focus of the West lab is neurobiology and neuropharmacology, and looking back it feels like fate that my interests lined up so well!

Deney Li

AF: I am majoring in neuroscience with minors in philosophy and chemistry, on the pre-med track. I knew I wanted to get into research at Duke because I had done research in high school and liked it. I started at the same time as Deney – we individually cold-emailed at the same time too, in the fall! I was always interested in neuroscience but wasn’t pre-med at the time. A friend in club basketball said her lab was looking for people, and the lab was focused on neurobiology – which ended up being the West lab!  

Amber Fu

What projects are you working on in lab?

DL: My work mainly involves immunoassays that test for Parkinson’s biomarkers. My postdoc is Yuan Yuan, and we’re looking at four drugs that are kinase inhibitors (kinases are enzymes that phosphorylate other proteins in the body, which turns them either on or off). We administer these drugs to mice and rats, and look at LRRK2, Rab10 and phosphorylated Rab10 protein levels in serum at different time points after administration. These protein levels are important and indicative because more progressive forms of Parkinson’s are related to higher levels of these proteins.

AF: For the past couple of years, I’ve been working under Zhiyong Liu (a postdoc in the lab). There are multiple factors affecting Parkinson’s, and different labs ones study different factors. The West lab largely studies genetic factors, but what we’re doing is unique for the lab. There’s been a lot of research on how nanoplastics can go past the blood-brain barrier, so we are studying how this relates to mechanisms involved in Parkinson’s disease. Nanoplastics can catalyze alpha-synuclein aggregation, which is a hallmark of the disease. Specifically, my project is trying to make our own polystyrene nanoplastics that are realistic to inject into animal models.

What I’m doing is totally different from Deney – I’m studying the mechanisms surrounding Parkinson’s, Deney is more about drug and treatments – but that’s what’s cool about this lab – there are so many different people, all studying different things but coming together to elucidate Parkinson’s.

Another important project

How much time do you spend in lab?

DL: I’m in lab Mondays, Wednesdays, and Fridays from 9 to 6. All my classes are on Tuesdays and Thursdays!

AF: I’m usually in lab Tuesdays and Thursdays from 12 to 4, Fridays from 9 to 11:45, and then whenever else I need to be.

Describe lab life in three words:

DL: Unexpected growth (can I just do two)?

AF: Rewarding, stimulating, eye-opening.

Lab life also entails goats and pumpkins

What’s one thing you like about lab work and one thing you hate?

DL: What I like about lab work is being able to trouble-shoot because it’s so satisfying. If I’m working on a big project, and a problem comes up, that forces me to be flexible and think on my toes. I have to utilize all the soft skills and thinking capabilities I’ve acquired in my 21 years of life and then apply them to what’s happening to the project. The adrenaline rush is fun! Something I don’t like is that there’s lots of uncertainty when it comes to lab work. It’s frustrating to not be able to solve all problems.

AF: I like how I’ve been able to learn so many technical skills, like cryosectioning. At first you think they’re repetitive, but they’re essential to doing experiments. A process may look easy, but there are technical things like how you hold your hand when you pipette that can make a difference in your results. Something I don’t like is how science can sometimes become people-centric and not focused on the quality of research. A lab is like a business – you have to be making money, getting your grants in – and while that’s life it’s also frustrating.

What do you want to do in the future post-Duke? How has research informed that?

DL: I want to do a Ph.D. in neuropharmacology. I’m really interested in research on neurodegeneration but also have been reading a lot about addiction. So I’ll either apply to graduate school this year or next year. My ultimate goal would be to get into the biotech startup sphere, but that’s more of a 30-years-down-the-road goal! Being in this lab has taught me a lot about the pros and cons of research, which I’m thankful for. Lab contradicts with my personality in some ways– I’m very spontaneous and flexible, but lab requires a schedule and regularity, and I like the fact that I’ve grown because of that.

AF: The future is so uncertain! I am currently pre-med, but want to take gap years, and I’m not quite sure what I want to do with them. Best case scenario is I go to London and study bioethics and the philosophy of medicine, which are two things I’m really interested in. They both influence how I think about science, medicine, and research in general. After medical school, though, I have been thinking a lot about doing palliative care. So if London doesn’t work out, I want to maybe work in hospice, and definitely wouldn’t be opposed to doing more research – but eventually, medical school.

What’s one thing about yourself right now that your younger, first-year self would be surprised to know?

DL: How well I take care of myself. I usually sleep eight hours a day, wake up to meditate in the mornings most days, listen to my podcasts… freshman-year-Deney survived on two hours of sleep and Redbull.

AF: Freshman year I had tons of expectations for myself and met them, and now I’m meeting my expectations less and less. Maybe that’s because I’m pushing myself in my expectations, or maybe because I’ve learned not to push myself that much in achieving them. I don’t necessarily sleep eight hours and meditate, but I am a little nicer to myself than I used to be, although I’m still working on it. Also, I didn’t face big failures before freshman year, but I’ve faced more now, and life is still okay. I’ve learned to believe that things work out.

A hard day’s work

Nursing’s Trial by Fire: COVID-19 and the Path Forward

The list of professions that have been pushed to the brink during the pandemic is ever-expanding. However, the sea change that swept over nursing in the past three years rivals that of almost any occupation, said panelists in a Sept. 28 event hosted by Duke University School of Nursing.

Already one of the most overworked professions, the pandemic only seemed to magnify nursing’s enduring problems, according to panelist and journalist Lauren Hilgers. A few months into the pandemic, nurses around the country began quitting in droves due to both burnout and undervaluation by their employers. As the front lines dwindled, hospitals working at full capacity needed to meet patient demand by any means necessary.

Enter travel nursing agencies, independent staffing organizations that matched nurses from across the country with hospitals dealing with acute labor shortages. Already increasing in popularity in the lead-up to the pandemic, demand for travel nurses in recent times has exploded. As this fundamental change in the make-up of the nursing labor pool occurred, people started to take notice.

In February of 2022, an article was published in the New York Times titled “Nurses Have Finally Learned What They’re Worth”. In the piece, Hilgers chronicles the major trends in the nursing workforce over the past three years. Hilgers describes the unique proposition facing the nurses who chose not to quit: remain as a staff nurse on their current salaries or sign up with a traveling agency and uproot their lives, albeit for higher pay. And the pay bump was substantial. Certain travel nurse jobs paid up to $10,000 a week, many times what staff nurses were earning. These nurses would often stay at a hospital anywhere from a couple of weeks to months, providing much-needed relief to healthcare systems. However, as the practice spread, questions soon began to emerge about the disparities in pay between staff and travel nurses, the sustainability of travel nurse programs, and, moreover, how the American healthcare system enabled travel nursing to rise to such prominence in the first place?

These questions served as the foundation of the Dean’s Lecture Series event, “The Value & Importance of the Nursing Health Care Workforce for U.S. Health and Wellbeing”. Moderated by Dean Vincent Guilano-Ramos PhD, the event featured Hilgers alongside a panel of distinguished speakers including Solomon Barraza, CCRN, cardiac ICU nurse at Northwest Texas Hospital, Benjamin Smallheer, PhD, Associate Professor at the School of Nursing, and Carolina Tennyson, DNP, Assistant Professor at the School of Nursing.

From left to right: Solomon Barraza, Lauren Hilgers, Vincent Guilano-Ramos, Benjamin Smallheer, Carolina Tennyson. Photo by Andrew Buchanan.

“Nursing is the largest segment of the healthcare workforce…yet what we contribute to the health and wellbeing of our country is invisible,” mentioned Dean Ramos at the discussion’s outset.

Smalheer agreed, adding that nurses today are contributing to patient care in ways that were vastly outside of their scope of practice just twenty years ago. A unique combination of technical proficiency, aptitude during crisis response, and ability to provide feelings of care and comfort, Hilgers describes nursing as one of, if not the only, profession in healthcare that considers the “entirety of a patient.”

A frequently cited statistic during the panel presentation referenced results from a Gallup poll indicating that nursing was rated as the most trusted profession for the 20th year in a row. While nurses were always aware of their influence and worth, getting healthcare systems to agree proved to be a much larger effort, one that only grew in importance as COVID-19 progressed.

“The pandemic has hardened us,” explains Smallheer. No longer were nurses willing to tolerate slights against their treatment as a profession. And they had tolerated plenty. Barraza, one of the protagonists of Hilgers’ piece, described the relentless search for purpose amidst constant burnout, especially during the pandemic’s heaviest waves. From finding efficient triage methods during a surge of cases to celebrating patient discharges, Barraza actively sought out ways to be “consistent when there was no consistency.” A charge nurse located in a region with severe labor shortages, Barraza had seen the influx of travel nurses firsthand every week. What ultimately kept him from traveling across the country in the pursuit of a more lucrative job, however, was the relationships he had forged within the hospital. Nurses, students, patients-they had all left an indelible mark on Barraza and enabled him to push through the long and grueling hours. Tennyson reinforced Barraza’s story by claiming that “you can be burnt out and still find value in a profession.” This seemingly contradictory duality may have proved sufficient to retain nurses during the pandemic, but as for long-term solutions, the panelists agree that significant change must occur at a systemic level.

Hilgers (pictured right) spent months speaking to nurses around the country, including Barraza (pictured left). Photo by Andrew Buchanan.

One of the central tensions of Hilgers’ article is that between the hospital and the worker. The explosion of travel nursing during the pandemic was but a manifestation of decades of undervaluation by hospitals of nurses. In order to undo this narrative and enact concrete change, Tennyson argues that nurses must be represented in more interdisciplinary professional spaces, from healthcare administration to policy to business. Hilgers restates this idea more broadly, saying that nurses “need to have a seat at the table” in reshaping the healthcare system post-COVID-19.

Much of this work begins at the level of the educational institution. Smallheer and Tennyson spoke at length about how nurses can better be prepared to navigate the ever-changing healthcare workforce. They both highlighted a few of the Duke School of Nursing’s novel instructional methods, including early exposure to complicated patient cases, extensive practice with end-of-life scenarios, and recognition of overstimulation points in the field. Also important for nurses-in-training and existing nurses, according to all panelists, was collective action. Through supporting state and national nursing associations, writing to local politicians, and speaking to healthcare administrators, they argued that nurses will be better equipped to voice their demands.

Christine Siegler Pearson Building at Duke University School of Nursing

As the panel reached its closing stages, one of the main talking points centered around changing the narrative of nursing as solely a burnout profession. Hilgers in particular remains critical of the portrayal of nurses, and more broadly those involved in care work, in popular media. She strongly advocates for authentic storytelling that including the voices of actual nurses, nurses such as Barraza. Ramos describes Barraza as someone who “represent[s] the best in nursing,” and the panelists maintained a strong desire to see such stories of resilience and passion spotlighted more frequently.

There is no simple formula to reform the nursing profession in the United States. However, through a combination of effective storytelling, more current educational standards, greater interdisciplinary involvement, and collective action, the panelists of the Dean’s Lecture Series firmly believe that lasting change is possible. 

Post by Vibhav Nandagiri, Class of 2025

Poetry and Pedagogy: The Push for Humanities Education in Medicine

“If language shapes inequitable systems, then their disruption relies in part on our ability to effectively wield language in subversive ways”

Dr. Irène Mathieu, MD
Dr. Mathieu reading from her award-winning 2017 book orogeny 

Buried within a smattering of bullet points and data nuggets, these evocative words flashed across the slide deck of Dr. Irène Mathieu, MD. As Assistant Professor of Pediatrics at the University of Virginia School of Medicine and an award-winning poet, Mathieu thinks medical students could benefit from a stronger background in the humanities. Over the course of her guest lecture, “Playing Between the Lines: Poetry by a Pediatrician,” Mathieu dropped many such pieces of wisdom linking the study of language, and more broadly the humanities, with the practice of medicine. She shared this wisdom through a variety of methods, including original poetry, anecdotes from her life, and the latest research into the field of narrative medicine. The lecture was organized by the Trent Center for Bioethics, Humanities, and History of Medicine and hosted by Dr. Sneha Mantri, MD, MS, Assistant Professor of Neurology at Duke University School of Medicine.

Published in 2016 and co-authored by Dr. Charon, “The Principles and Practice of Narrative Medicine” is considered as one of the influential works in the field. 

The field of narrative medicine, hardly twenty years old, can trace its roots to Columbia University, when a group of physicians and scholars, spearheaded by Dr. Rita Charon, MD, PhD, sought to change the discourse surrounding traditional medical training. Emphasizing various humanities-based approaches, narrative medicine seeks to increase the propensity of physicians to perceive strife, uncertainty, and complexity in the pursuit of caring for complex illnesses. In her discussion, Mathieu cited multiple studies that detail the positive impact of an exposure to the humanities on the empathy, wisdom, tolerance for ambiguity, and resistance to burnout in medical students. More recent studies have shown that narrative medicine experimental training programs have similar impacts.

Like many of her contemporaries, Mathieu sees the utility in narrative medicine to impact not only the personal lives of physicians, but also the systems in which they interact. By approaching treatment through the lens of narrative medicine, she believes that physicians can better reimagine health systems into more equitable entities. In her pursuit of greater health equity, Mathieu identified two concepts that every physician should strive to possess: structural competency and critical consciousness. Structural competency, a term coined by her colleagues in an influential 2014 paper, proposes a model of patient engagement that goes beyond the realm of cultural awareness and further into understanding upstream, systemic issues such as zoning laws, food delivery systems, and health insurance. Critical consciousness, the ability to recognize the inherent contradictions and inequities within society, complements the structural competency framework. By consistently engaging in critical reading and reasoning, future physicians will be better able to reflect on the “power, privilege, and the inequities embedded within social relationships”.

While Mathieu recognized the power of narrative medicine, she also acknowledged how poetry has never had its proper place within the prose-heavy field. In her eyes, however, incorporating poetry into narrative medicine frameworks makes a lot of sense. For one, it allows a deeper level of vulnerability and dynamicity that literary fiction and theory cannot provide. More practically, however, poetry tends to err on the shorter side of literature (Mathieu calls them “multisensory micro-stories”), offering a less time-consuming alternative for busy medical students and residents.

For most of Mathieu’s life, her passion for poetry and medicine developed on parallel tracks. It wasn’t until her undergraduate years that she began to think of poetry more externally and started to seek out opportunities for publication. Around the same time, through her work in various global health initiatives, she witnessed the power words and policy can possess over the healthcare needs of entire populations. She identified a need for a humanities education, replete with poetry and theory and fiction, as critical to increasing equity within the healthcare system. When Mathieu assumed her latest role at UVA, on the eve of publishing her third poetry collection, the critically acclaimed Grand Marronage, she was given the opportunity to integrate her poetry within the university medical curriculum. Today, Mathieu has a secondary appointment as Assistant Director of the Program in Health Humanities at UVA’s Center for Health Humanities and Ethics. The parallel pathways of her life had converged.

As Mathieu revealed during her presentation, much of her poetry has little to do with her daily medical practice. Rather, she views poetry more along the lines of an escape. This escape takes the form of a critical reflection, by connecting the quotidian with themes of family and love, excess and presence. Mathieu’s poetry has the rare ability to walk readers through her complete narrative process, from the barest of sensory details to the ambiguities of emotion.

Perhaps there is no more fitting an ending to this article than an invitation to join Mathieu’s narrative world. After all, no amount of prose can substitute for a real poem. Below is a particularly striking excerpt of Mathieu’s artistry from the first stanza of her poem, “the forest fire of family trees”:

the problem is we don't know
that many ways of doing things
for instance, neither of us can
fry an egg without public radio
chattering in our ears, & there
are worse blueprints for a home,
like what my grandfather taught
my uncle. we think we know
people until we see the way
they eat a banana, totally unlike
how we peel and devour the fruit,
only instead of eating a banana
it's something way bigger,
like loving another person.
Post by Vibhav Nandagiri, Class of 2025

What are Healthcare Researchers Doing to Address Health Equity?

“Community engagement” and “health disparities” are some of the most trending terms in healthcare right now, but what are people actually doing about them? On Wednesday, February 2, panelists in healthcare sat down as part of Duke’s Research Week to talk about ways in which they and their organizations were actively addressing health disparities by focusing on communities. (View the session)

Dr. L. Ebony Boulware, professor at the Duke University School of Medicine and director of the Duke Clinical and Translational Science Institute, set the stage by defining health equity for the vast number of us that might only have read about it in a mission statement or an article but weren’t exactly sure how it was conceptualized. To work towards health equity, she said, means that “everyone has an opportunity to attain their full health potential regardless of any socially defined circumstance.” These circumstances could range from poverty to structural racism, but the main theme was that community engagement is a key player as we think about how best to achieve equity.

Slide taken from Dr. L. Ebony Boulware’s presentation.

COVID-19 is a great example of why health equity matters, as we ponder whether the pandemic could have turned out any different if more people had access to vaccines, personal protective equipment, and the capacity to socially distance. Dr. Michael Cohen-Wolkowiez, a professor of Pediatrics at the Duke University School of Medicine, and Dr. Giselle Corbie-Smith, a professor at the UNC School of Medicine gave a pertinent example of their work addressing the health disparity on our minds right now– access to COVID-19 testing – and the RADx program out of the NIH that is funding work to address this problem.

But even before COVID-19, attaining health equity was a tough goal to address for virtually every country in the world. Health equity isn’t just a nicety, it affects how long we are alive. And while progress in terms of life expectancy differences is improving, much work remains to be done to close the myriad gaps that remain. Dr. Tyson Brown, associate professor of Sociology at Duke, highlighted his research into structural racism to stress the fact that structural racism is toxic for population health and disproportionately affects people of color.

Slide taken from Dr. Tyson Brown’s presentation.

Dr. Schenita Davis Randolph, a registered nurse and professor at the Duke School of Nursing, zoomed in a little to highlight what true community engagement looks like. As part of her lab’s research to improve uptake of pre-exposure prophylaxis (PrEP) treatment to address HIV in Black women, they designed an intervention for beauty salons, known to be trusted venues for health promotion in the Black female community. But “how do we use community engagement so it’s not just a checkmark?” This, among other pressing challenges to community engagement in addressing health disparities, is what Dr. Keisha Bentley-Edwards, developmental psychologist and professor at the Duke University School of Medicine, talked about.

As the panel discussion came to a close, a key message emerged. As Dr. Davis remarked, both disparities and the communities that are hurt by them are complex, and so until we take a multi-faceted approach to understanding them, we continue to grasp for the ultimate goal of health equity.

But while these disparities are complex, they are certainly not unsolvable. Dr. Corbie-Smith emphasized that “we have a clear understanding of of how health disparities work.” All that’s left to do is solve them, and Dr. Bentley-Edwards highlights this move from awareness to solutions as a challenge to achieving health equity. Perhaps most significantly, though, it’s important to move from inertia to action. While there are seemingly thousands of ways in which communities in the U.S and around the world face barriers to health access, it’s important to do something – however small. As Dr. Bentley-Edwards concluded, by everyone working within their sphere of influence to close the health equity gap, that sphere becomes bigger and bigger and the gap becomes smaller and smaller.   

LowCostomy: the Low-Cost Colostomy Bag for Africa

It’s common for a Pratt engineering student like me to be surrounded by incredible individuals who work hard on their revolutionary projects. I am always in awe when I speak to my peers about their designs and processes.

So, I couldn’t help but talk to sophomore Joanna Peng about her project: LowCostomy.

Rising from the EGR101 class during her freshman year, the project is about building  a low-cost colostomy bag — a device that collects excrement outside the patient after they’ve had their colon removed in surgery. Her device is intended for use in under-resourced Sub-Saharan Africa.

“The rates in colorectal cancer are rising in Africa, making this a global health issue,” Peng says. “This is a project to promote health care equality.”

The solution? Multiple plastic bags with recycled cloth and water bottles attached, and a beeswax buffer.

“We had to meet two criteria: it had to be low cost; our max being five cents. And the second criteria was that it had to be environmentally friendly. We decided to make this bag out of recycled materials,” Peng says. 

Prototype of the LowCostomy bag

For now, the team’s device has succeeded in all of their testing phases. From using their professor’s dog feces for odor testing, to running around Duke with the device wrapped around them for stability testing, the team now look forward to improving their device and testing procedures.

“We are now looking into clinical testing with the beeswax buffer to see whether or not it truly is comfortable and doesn’t cause other health problems,” Peng explains.

Poster with details of the team’s testing and procedures

Peng’s group have worked long hours on their design, which didn’t go unnoticed by the National Institutes of Health (NIH). Out of the five prizes they give to university students to continue their research, the NIH awarded Peng and her peers a $15,000 prize for cancer device building. She is planning to use the money on clinical testing to take a step closer to their goal of bringing their device to Africa.

Peng shows an example of the beeswax port buffer (above). The design team of Amy Guan, Alanna Manfredini, Joanna Peng, and Darienne Rogers (L-R).

“All of us are still fiercely passionate about this project, so I’m excited,” Peng says. “There have been very few teams that have gotten this far, so we are in this no-man’s land where we are on our own.”

She and her team continue with their research in their EGR102 class, working diligently so that their ideas can become a reality and help those in need.

Post by Camila Cordero, Class of 2025

The COVID-19 ‘Endgame’ Depends on Where You Live

In February of 2020, no one could have fathomed that the very next month would usher in the COVID-19 pandemic – an era of global history that has (to date) resulted in 5 million deaths, 240 million cases, trillions of dollars lost, and the worsening of every inequality imaginable.

And while scientists and governments have worked together to make incredible advances in vaccine technology, access, and distribution, it goes without saying that there is more work to be done to finally put the pieces of an exhausted global society back together. On Tuesday, October 12th, the Duke Global Health Institute (DGHI) brought together three leaders in global health to discuss what those next steps should be.

The panel discussion, which was moderated by Dr. Krishna Udayakumar of the DGHI, was titled “The COVID-19 Endgame: Where are we headed, and when will we get there?” The panelists were Dr. Ann Lindstrand, who is the World Health Organization’s unit head for the Essential Program on Immunization; Dr. Ayoade Alakija, who is the co-chair of the African Vaccine Delivery Alliance and founder of the Emergency Coordination Center in Nigeria; and Alberto Valenzuela, who is the Executive Director of the Pan American and Parapan American Games Legacy Project.

Dr. Ayoade Alakija
Dr. Ann Linstrand
Alberto Valenzuela

Dr. Lindstrand began by setting the stage and highlighting what are undoubted successes on a global level. 6.5 billion doses of the vaccine have been administered around the world, and the vaccines have impressive effectiveness given the speed with which they were developed. Yet undergirding all of this is the elephant in the room that, sitting in a 1st-world country, we don’t think about: high-income countries have administered 32 times more doses per inhabitant compared to low-income countries.

Graph from Dr. Ann Lindstrand

This vaccine inequity has been exacerbated by already weak health security systems, vaccine nationalism, and lackluster political commitment. And while the WHO is slated to enormously ramp up supplies of vaccines in Q4 of 2021 and Q1 of 2022, it doesn’t mitigate the damage to the socioeconomic welfare of people that COVID-19 has already had. Dr. Lindstrand outlines the three waves of socioeconomic impact we will see, but expressed concern that “we’re already beginning to see the first wave pan out.” 

Diagram from Dr. Ann Lindstrand

Dr. Alakija took this discussion a step further, asserting that COVID-19 is poised to become the disease of low-income countries. “If you’re living in the US or EU,” she remarked, “You’re heading into the ‘Roaring 20s’. If you live in the Global South, COVID-19 is going to become your future.”

To this point, Dr. Alakija emphasized that the only reason this is the status quo is because in her eyes, the world failed to do what was right when it should have. In her home country of Nigeria, she highlighted that out of a population of 210 million people, 5.1 million people have received the vaccine – and of those 5.1 million, just 2 million — one percent — have been double-vaccinated. “It really is a case of keeping those down further down, while giving booster doses to those that have already been vaccinated,” she said. “We don’t have diagnostic data, so people are slipping underwater and the world has no idea.”

It’s worth noting that Nigeria houses some of the megacities of the world, not just in the African continent. So according to Dr. Alakija, “we don’t solve this with a medical lens, we solve this with a whole-of-society lens.” We must, she argued, because in an interconnected world, no one exists in isolation.

Alberto Valenzuela’s work is a great example of this. In 2019, his team led organizing efforts for the Pan American Games in Lima, relying on extensive partnerships between public organizations and corporations. In 2020, though, as the world shifted, the government called on the team to transition into something much different – COVID-19 relief efforts in the country.

The results are staggering. In just 5 weeks, the Pan American and Parapan American Games Legacy Project built 10 hospitals in 5 regions of the country. The implementation of 31 vaccination centers throughout the country resulted in a tripling of the number of people vaccinated per day in Lima. To him, this work “proves what’s possible when private and public sectors merge.” In other words, remarkable things happen when all of society tackles a societal issue.

Slide from Alberto Valenzuela

So where do we go from here? Perhaps the biggest thing that stood out was the need to empower low-income countries to make decisions that are best for them. In Dr. Alakija’s words, “we need to lose the charity model in favor of a partnership model.” Dr. Lindstrand pointed out that there’s a deep know-how in the Global South of how to roll out mass-vaccination efforts – but only when we “lay down our organizational hats” can we move to what Dr. Lindstrand termed “more coordination and less confusion.” Valenzuela emphasized the need to integrate many sectors, not just healthcare, to mobilize the COVID-19 response in countries. But above all, Dr. Alakija said, “there will be no endgame until we have equity, inclusion, and health justice.” 

Post by Meghna Datta, Class of 2023

The Duke Dentist and her Research: Saving Children’s Teeth, One Tooth at a Time

Walking into our small meeting room with green scrubs and a white lab coat on, our special guest set her bag down in the front and stated “I fixed 60 teeth today and haven’t sat down since this morning.” To us, it sounds like a nightmare, but to Dr. Martha Ann Keels, working in her clinic and conducting dental research is a dream come true. 

Born and raised in North Carolina, Dr. Keels has kept her roots as she studied here at Duke. As a Duke undergrad, she received her bachelor’s degree in Chemistry and a minor in Art History, later choosing to become a pediatric dentist at UNC. It wasn’t long until she returned back to Duke to volunteer at Duke’s Children Hospital, and in 1986, she became the first pediatric dentist to get privileges to practice at Duke. She continues to run her own clinical practice alongside Duke Health System to this day, working for over 30 years!

“I get to feel the satisfaction that something I used my hands for helped alleviate pain in children,” Keels said. “I also get to watch them grow as they come in over the years. It feels super rewarding.”

With her passion and dedication, not only does she help those that enter her office, but she also conducts research on the side, wanting to help dentists all over.

Dr. Keels currently has her hands dirty with a major research project she has been working on for the past nine years. According to the National Institute of Dental and Craniofacial Research, 42% of children between the ages of two to eleven years old have at least one cavity in their primary teeth, and 23% of those children are untreated. With how high these numbers are, she and a group of other researchers are trying to develop tools that allow pediatricians and pediatric dentists to be able to identify high risk factors of cavities in children and care for them before they do occur; tools like questionnaires, surveys, and ‘top 5 predictors…’.

Table of percentages of children with cavities corresponding to age, sex, race, and poverty (National Institute of Dental and Craniofacial Research)

By observing a group of 1,300 children ever since birth, they have been analyzing all aspects of each child: collecting saliva, looking at biofilm (more commonly known as plaque), physical deformities in their teeth, and even social factors like parents’ dental experience. 

Despite the children still being fairly young, Dr. Keels reveals that a surprising amount of information has been found. “No one has ever looked at tight teeth– when your teeth are closely spaced– but we are seeing that it puts a child at high risk of cavities,” Keels said. She also adds that they have also begun to identify which types of bacteria help with reducing chances of getting a cavity, as well as bacteria that bring a high risk of creating a cavity.

 This also goes hand in hand with the microbiomes in our mouths. Dentists first believed that the microbiomes of the child’s caregiver affected the child’s microbiome, in the sense that their microbiomes would be similar from the beginning. Dr. Keels’s study says otherwise. It’s being shown that a child’s microbiome starts off as its own, unique microbiome, and it is over time that it begins to become similar to their caregiver’s microbiome.

With the vast amount of information already collected, Dr. Keels and her team continue to persevere, now wanting to push the study for another five more years. They want to start working with adolescents, wanting to also analyze mental states and how that might affect their dental hygiene and risks of cavities. 

Maybe in the near future, as you speak to your dentist at your next appointment, and they bring up a list of risk factors for cavities, who knows? That list or table could be coming from the one and only Dr. Martha Ann Keels.

Post by Camila Cordero, Class of 2025

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