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Sandwich Scholars Return to Kenya The Infectious Disease Research Training Program (IDRTP) graduated two new Sandwich scholars, as Everlyne Nyaboke Ombati and Hilary Kagume Njenge returned to Kenya after successfully completing two months of clinical research training at UCSF. Ombati and Njenge returned to Nairobi on September 24th to complete their MSc degrees at ITROMID, an institute of the Kenya Medical Research Institute (KEMRI). KEMRI and UCSF jointly administer the IDRTP, which provides clinical and basic science research training focused on sexually transmitted infections. IDRTP works to increase research capacity on STIs within Kenya and to facilitate collaborative relationships between researchers at both universities. Ombati and Njenge were accepted to the highly competitive program as Short Term Scholars in Clinical Epidemiology. The Short Term program includes the Training in Clinical Research (TICR) Summer Workshop as well as supervised work in UCSF labs to assist the scholars in developing independent research proposals. The scholars will complete this research following their return to KEMRI. Ombati, an MSc student in Microbiology, developed a research plan to evaluate the prevalence and risk factors of STIs among young women in Kisumu, Kenya. She worked in the San Mateo County Public Health Laboratory in order to gain additional experience in sensitive STI diagnostic methods, and described this experience as the highlight of her time in San Francisco. She credited the design and development of her research proposal to the extensive peer discussion and critiques in the TICR program. "My time at UCSF opened my thinking and I would like to do a PhD in Global Health," said Ombati. Njenge is in the second year of his MSc in Public Health, and has focused his research interests on the prevalence of Hepatitis B and C in HIV discordant couples. Under the guidance of Dr. Michael Busch at the Blood Systems Research Institute, Njenge explored his interest in blood transmission of STIs and developed research collaborations to continue following his return to Kenya. Learning how to do clinical research is a key goal of the sandwich program because such training is not available in Kenya. "The best part of my time at UCSF was attending the courses on Developing a Career in Clinical Research and Designing Clinical Research," Njenge noted. Like Everlyne Ombati, Njenge's experience here has inspired him to pursue a PhD in the future. Sustained mentoring at both UCSF and KEMRI is a critical component of trainee success in the program. Both Ombati and Njenge will remain in contact with their mentors after leaving UCSF. Having now returned to Kenya to complete their research projects and graduate degrees, Ombati and Njenge will join the three 2006 Sandwich Certificate Scholars as part of the growing cohort of Kenyan researchers equipped to confront the STI epidemic in East Africa. "STIs are a major health threat in Kenya, "said Dr. Craig Cohen, co-director of the program, "and the country desperately needs trained scientists to combat it. The IDRTP program is making an important contribution to meeting this need." For more information:
Mount Zion Health Fund Supports GHS Clinical Scholars In its most recent round of funding, the Mount Zion Health Fund awarded a grant to the GHS Clinical Scholars Program to support in-country scholarly projects. Five individuals from the first class of scholars competed successfully for funding to complete their projects, all of which are located in East Africa. The two-year Global Health Sciences Clinical Scholars Program is now in its second year. The class of 2006 comprised 16 participants from seven departments in the School of Medicine. This year's class of 24 scholars represents 11 disciplines including nursing and dentistry. The diverse composition of the program supports interdisciplinary interaction and collaboration of health care professional trainees within UCSF who have career interests in global health. The program begins with a three week daily course in September with faculty speakers from UCSF, UCB, and other universities such as University of Pennsylvania and Stanford .Topics of discussion are wide-ranging and include workforce issues, HIV/AIDS, malaria, TB, NGOs, polio, international research, maternal/child health, and project evaluation, to name a few. From the start, scholars are encouraged to formulate and develop a global health project that will involve at least one month of work in a developing country or a relevant local site. The five scholars whose projects will be supported by the Mount Zion Health Fund are: Richard Brooks, MD, Internal Medicine. In order to free up the more highly trained doctors and nurses for complex cases, routine patient care has been shifted to medical assistants at the Family AIDS Care and Education (FACES) clinical site in Kisumu, Kenya. To assist this cadre of workers in carrying out their tasks and improve the quality of patient care, Brooks will work to develop and organize into a handbook guidelines for medications, diagnostic tests and resources. Lisa Dillabaugh, MD, Pediatrics. Dillabaugh's research project, also at FACES in Kisumu, attempts to corroborate the findings of Zar, et al., in South Africa of the efficacy of isoniazid preventive therapy (IPT) in HIV-infected children. The project will also be designed to evaluate the optimal duration of treatment, benefit of IPT among children on ARVs, and the value of chest X-rays in screening asymptomatic HIV-infected children. She will work with the local staff to develop an implementation plan. Charles Everett, MD, Internal Medicine. Everett will study the relationship between distances patients must travel to clinics or pharmacies and HIV antiretroviral therapy treatment failure in locations of each homestead in the Uganda Antiretroviral Treatment Outcomes (UARTO) Cohort in rural Mbarara, Uganda. Prasanna Jagannathan, MD, Internal Medicine. Malaria is a leading cause of death in the children of Uganda. Jagannathan's longitudinal study compares the safety and tolerability of combination antimalarial therapies in Ugandan children. He will analyze data that is currently being collected comparing the efficacy of three leading antimalarial combination regimens in Kampala, Uganda in 617 children over four years. Measures of adverse events of interest will include any adverse event, any serious adverse event, any adverse event stratified by type (sign, symptom, and laboratory abnormality), and any adverse event stratified by severity and relationship score. Krista Powell, MD, Internal Medicine. is working on a project to improve knowledge for healthcare workers of the diagnosis of acid fast bacilli (AFB) smear-negative tuberculosis infection among HIV-infected patients in Uganda. She will disseminate the data and educational curriculum to aid in the improvement of patient care at the Mulago Hospital in Kampala, Uganda. The purpose of the Clinical Scholars program is to contribute to the healthcare workforce a cadre of professionals who understand the most pressing global health issues and have the skills to help solve them. Prasanna Jagannathan illustrates the global health scholar very well. As a future infectious disease specialist, through presenting his data to local Ugandan health ministries he hopes to "...develop insight and skills into the intersection of science, public health, and policy, an area which I hope will form a major part of my future career in global health." Scholars work with UCSF faculty and physicians and healthcare workers on-site. In the spring, a symposium at Mount Zion will bring these five scholars together to share their findings with the academic and local community.
Mental Health in India: In March 2007 Dr. Peter Ferren, an assistant clinical professor in the Department of Psychiatry, traveled to Vellore, India as the first Global Health Faculty Scholar. Dr. Ferren served as a volunteer faculty at Christian Medical College (CMC) in the Child and Adolescent Psychiatry section of the Department of Psychiatry. He also engaged CMC leaders in discussions on strengthening collaborations with UCSF. What was your role during the visit? I engaged in four major areas of activity. They asked me to give some prepared presentations on mutually agreed upon topics to the child psychiatry and general psychiatry trainees, faculty, and multidisciplinary staff. I also provided some direct consultation and clinical supervision of ongoing assessments and treatment. The purpose was to enhance diagnostic and treatment knowledge and skills. A third role was an informal needs assessment of the child psychiatry service. That resulted in my impromptu presentations on competency-based curricula and residency training from the US perspective. I also gave a demonstration of play therapy with a child. Finally, I led discussions on the commonalities and differences in the treatment of children and families in the US and Indian cultural contexts. In addition, I met with the administration to engage in discussions for ongoing collaboration. What specific activities did you participate in during the visit? I participated in all activities on the usual Monday through Saturday child psychiatry schedule including inpatient rounds, outpatient rounds, outpatient clinic, consultation to pediatrics, and teaching activities. I was also given special tours of the medical center, an orphanage, and some of the surrounding area to understand the cultural context. What were the most pressing needs that you witnessed in the child and adolescent psychiatry department? Child psychiatry is controversial in India and has political obstacles, so a pressing need is professional support in developing a child psychiatry training program. I provided some program components characteristic of US training, but I also gave moral support for the chief psychiatrist to pursue his goal despite the many obstacles. From a clinical perspective, a big need is the introduction of psychodyamic principles and play therapy with younger children to complement the medical model of treatment in the Indian cultural context. Another high need area is identifying effective treatment modalities for psychiatric problems that cannot be readily solved with medication, such as personality disorder pathology. There is also a need to improve the recognition of traumatic experience, particularly the effects of culturally-endemic domestic violence, and to expand the concept of posttraumatic stress disorder and its treatment. How did your work at CMC compare with your work at UCSF? In some ways, the work is exactly the same. Kids are kids, families are families, trainees are trainees, clinics are clinics, and the mental health problems are the same. We had many a chuckle at experiencing the same challenges. The major difference is that the department in India is primarily physicians with a medical orientation whereas my clinic at SFGH is primarily psychologist-driven with an emphasis on psychotherapy over medication. Ironically, there were more faculty child psychiatrists - three -- at CMC compared to just myself at SFGH! What advice would you give to another faculty member interested in being a Faculty Scholar? I would enter the experience prepared to teach on a variety of topics of expertise but be flexible in the field to develop impromptu presentations on topics that are identified once one is there. It is important to have an attitude of mutual exchange of ideas; in my experience, there were several areas of expertise that my Indian hosts had that exceeded my knowledge and experience and from which I benefited tremendously. I would also be prepared to respect highly the quality of training and care, especially in India, which, despite being a medium-income country with an impoverished population, is providing world-class treatment and attracting an international patient population. Were any moments particularly memorable? Some of the most memorable moments included observing parents from a variety of socioeconomic and religious backgrounds working together with their severely retarded and autistic children in a residential treatment setting under staff guidance. In an impoverished country where the disabled are often cast aside, it was quite moving to meet a group of parents who were making an investment of time, money, and energy in their disabled children. I also remember demonstrating evaluation of a child through play behind a one-way mirror. It was both surprising and exciting to this child who did not expect a doctor to play with him as a means of evaluation and communication. When the session ended, I had forgotten that it was standing room only behind the mirror as the faculty, staff, and trainees were equally enthusiastic about a traditional technique of child psychiatry that has been lost in their medically-driven clinic. Finally, I enjoyed walking to and from the clinic several times a day passing under a giant tree filled with fruit bats that reminded me that I was far from San Francisco! Global Health Faculty Scholars Program
Clinical Scholars class of 2007-09 accepted The Global Health Clinical Scholars Program (GHCSP) has admitted the second class of scholars to the program. The 25 health professionals enrolled in the program for 2007 to 2009 will undertake academic training and practical experiences in global health as part of their residency training. The new cohort is unprecedented in its disciplinary diversity, including scholars from the School of Nursing and School of Dentistry as well as the School of Medicine. Eleven disciplines are represented in the program this year: Advanced Community Health and International Nursing, Family and Community Medicine, Family Nursing, Internal Medicine, Obstetrics and Gynecology, Orthopaedic Surgery, Pediatrics, Pediatric Dentistry, Surgery, Urology, and Womens Health Nursing and Midwifery. The scholars will each undertake projects in a developing country, contributing their clinical and research expertise to global health challenges. The 2007 2009 scholars are:
Joy Anglin, Pediatrics
Science, Technology & Health in Africa Global Health Sciences held its Spring Lecture, Science, Technology & Health in Africa, at Mission Bay on May 2. As reported in UCSF Today, keynote speaker and UCSF Medal recipient, Dr. Mamphela Ramphele discussed women's health as a key to economic prosperity in Africa in her address, The Know-Do Gap in Global Health. Also on the agenda, Narciso Matos of the Carnegie Corporation and Winston Soboyejo, Chair of the African Scientific Committee of the Nelson Mandela Institutions, talked respectively about increasing education's reach and the scientific and technical capacity of Africa.
Scholars Address Health Diplomacy with North Korea 
The Global Health Diplomacy Seminar series continued with its second campus seminar on March 22nd, 2007. Three international experts on North Korea addressed the question, "Can Health Professionals Save the World?" in discussing the current humanitarian crisis and international political situation related to North Korea. Vincanne Adams, PhD, welcomed the speakers and noted that the health diplomacy initiative, a joint project of UCSF Global Health Sciences and the Institute on Global Conflict and Cooperation (IGCC) , recently convened a group of scholars and practitioners from fields of health, anthropology, and international relations to begin to define health diplomacy. From this intellectual exchange emerged the concept of health diplomacy as a political change agent with the goal of improving health and the potential impact of simultaneously mediating international relations. In that context, the current situation concerning North Korea presents a case study of current humanitarian efforts and potential areas for future intervention. The three speakers were Susan Shirk, PhD, Director of IGCC and a Professor at UC San Diego; Stephan Haggard, Lawrence and Sallye Krause Professor of Korea-Pacific Studies at UCSD; and Hazel Smith, Professor of International Relations at the University of Warwick. The panel was moderated by Ricky Choi, MD, MPH, Pediatrics resident at UCSF. The speakers provided an overview of the humanitarian and political situation in North Korea as well as the interventions currently underway. North Korea was the industrial center of the Korean peninsula in the early 1900s. Shortly after the Korean war (1950 - 1953), North Korea emerged as a regional leader in health care and economic growth. However, by the early 1980s, the economy began to decline. The fall of socialist countries, in particular the USSR, resulted in a loss in trading partners and sources of energy that had been essential to maintaining the country's input-intensive agriculture. The agricultural sector declined substantially, leaving it vulnerable to complete collapse when the country was wracked by floods and droughts in the mid 1990s. The resulting famine caused an estimated 600,000 to 1,000,000 deaths, three to five percent of the total population. Humanitarian aid was slow to arrive, the public distribution system could no longer supply food at a survival level, and households attempted to compensate for the deficit by turning to the market. The crisis was particularly severe in urban areas such as the northeast coast, which is marked by densely populated former industrial cities without accessible arable land. The effects of this period, known as the arduous march by the North Korean people, remain evident today in the continuing high levels of malnutrition and stunting as well as in the recent re-emergence of diseases of poverty such as malaria, measles, and tuberculosis, testament to the lack of resources within the national healthcare system. Households continue to face two forms of instability: the erratic public distribution system and volatile market prices. In the face of this humanitarian disaster, aid has entered the country through a variety of channels, including bilateral initiatives, multilateral agencies, and non-governmental organizations (NGOs). The focus of such programs has been food aid, with medical assistance and health a far lower priority. Though the Red Cross in particular has worked to restore local hospitals and UNICEF and WHO have collaborated with the government on polio vaccination, the healthcare system is extremely resource limited at present. The current political situation has eclipsed the humanitarian situation in North Korea, with the recent renewal of the Six Party talks following North Korea's nuclear test in October, 2006. The Six Party de-nuclearization agreement is designed as a bilateral, reciprocal test with short timelines in order to document concrete progress. The first phase recently reached its halfway point, but the scheduled assessment meeting was called off due to North Korea's refusal to meet after an early benchmark (the release of capital frozen outside of the country) was not achieved. The talks are complicated by three underlying factors: lack of trust among the parties, lack of internal consensus within the United States and North Korea, and the challenge of essentially conducting bilateral negotiations with certain multilateral aspects. Of the five Working Groups, only the group focused on normalization of US-DPRK relations is discussing humanitarian assistance, making it a possible site to apply health diplomacy. The Working Group on economy and energy is currently focused on obtaining heavy fuel oil, but perhaps in the second phase they might be able to include an increased focus on international cooperation in other areas to improve the country's economy. Opening channels outside of traditional international trade and, such as capacity building and medical exchange, could provide entirely new ways of engaging North Korea.
GHS is in the News! Global Health Sciences has recently been featured on the UCSF Today website. To read more, visit the articles on our 2007 Presidential Chair, Jaime Seplveda, our postdoctoral scholar, Selma Omer, and the recent signing of letters of intent to collaborate with Vietnam.
New Sandwich Certificate Scholars Admitted! The KEMRI-UCSF Infectious Disease Research Training Program has admitted four new scholars for 2007 2008. This program provides students enrolled in MSc or PhD programs at the Jomo-Kenyatta University of Agriculture and Technology (JKUAT) with basic science or clinical epidemiology training at UCSF. The 2007 scholars will arrive in San Francisco in July. The Major Pathway scholar will spend a full year and the three Short-Term Track scholars will be at UCSF for three months, undertaking lab rotations and completing coursework. The Major Pathway student will receive a Certificate in Global Health Sciences from UCSF before returning to JKUAT to complete his PhD. The scholars for 2007 2008 are: Benjamin Mbiyu Ngugi, MBChB, MPhil Hilary Kagume Njenge, BSc Everlyne Nyaboke Ombati, BSc Charles Waigwa Wachichi, MBChB For more information on the IDRTP, see the Sandwich Certificate page.
GHS hosts seminar on Iran and health diplomacy 
UCSF Global Health Sciences kicked off a new seminar series on Global Health Diplomacy with a special panel on HIV Prevention in Iran on February 12th, 2007. Researchers from UCSF, UC Berkeley, and Tehran University of Medical Sciences discussed the challenges and promises of HIV research in Iran, focusing on the impact of academic collaboration. GHS Education Coordinator Tom Novotny, MD, MPH, introduced the session by describing the overall Global Health Diplomacy initiative as supporting research and training to improve health while strengthening international relations, especially in situations of diplomatic failure such as Iran. The new seminar series will highlight current and potential examples of health diplomacy at work. Nooshin Razani, MD, MPH, a postdoctoral fellow at the Center for AIDS Prevention Studies (CAPS) began the session by outlining the current health situation in Iran as well as the historical and present-day challenges the nation faces. Mohsen Malekinejad, MD, MPH, a doctoral student at the Berkeley School of Public Health, related the status of HIV in Iran today, noting that while the prevalence remains relatively low, newly identified cases have increased rapidly in recent years. Transmission is most often via injection drug use, which poses a particular challenge in Iran given the high rate of drug use and the geographical position of the country along the global drug trade. The Iranian government has recently begun to adopt a harm reduction approach towards drug use, facilitating HIV prevention and treatment activities. Parastoo Khairandish, MD, MPH, detailed her work as the General Manager of the Iranian Research Center for HIV/AIDS, noting that in the few years since its founding, the Center has played a key role in providing services for HIV positive individuals and in improving the clinical care of these patients. In addition, in collaboration with researchers from UCSF and UC Berkeley, researchers at the Center are conducting focus groups with injection drug users in Tehran, with the ultimate goal of improving HIV prevention efforts in the city. Dr. Khairandish was visiting UCSF and UC Berkeley as one part of this ongoing collaboration. Neda Farzan, a second year medical student, recounted her experience working at the Center in 2006. The speakers echoed the theme of collaboration and personal contact as a means of both overcoming political barriers and advancing health. Dr. Razani encouraged all attendees to take action on political as well as medical fronts to ensure peaceful resolution of international conflicts. The next Health Diplomacy seminar will take place on March 22nd and will focus on the role of health diplomacy in dealings with North Korea. In addition to GHS, the Institute on Global Conflict and Cooperation supports this new Initiative. For questions, please contact GHS Education Programs.
GHS-Vietnam Collaborations 
GHS-Vietnam collaborative relationships continue to grow and develop as a direct consequence of a June 2006 GHS delegation to Ho Chi Minh City (HCMC). Meetings that were held with officials and faculty of HCMC University of Medicine and Pharmacy (UMP), HCMC City Health Department, and with the leadership of the Royal Melbourne Institute of Technology-Vietnam (RMIT), have now resulted in executed Letters of Intent to Collaborate (LOI). On October 26, 2006, Executive Director Haile Debas and HCMC UMP Chancellor Nguyen Dinh Hoi signed a Letter of Intent to Collaborate (LOI) in three areas: faculty development; health sciences education planning and development; and joint research. A six-person joint planning committee is expected to issue a report and recommendations sometime in February. An early product of the relationship is expected to be a periodic visiting professorship with UCSF faculty providing seminars and lectures. On January 10, 2007, an LOI was signed by Haile Debas and Chancellor Margaret Gardner of RMIT to explore development of joint educational programs to train Vietnamese healthcare professionals in management and health care administration. Last year HCMC City Health Department director Nguyen The Dung sought GHSs assistance to develop such a program for administrators for the 28 public and 22 private hospitals for which the city has either direct responsibility or quality oversight. As the idea was more widely discussed, it became clear that there was a country-wide need, thus providing the impetus to develop a formal certificate/degree program with RMIT. UCSF faculty and staff directly involved in planning are Neal Cohen, vice dean/school of medicine; Jeff Mandel, co-director, Center for AIDS Prevention Studies; Dominic Montague, assistant professor/epidemiology & biostatistics; and Chuck Smukler, GHS interim director/administration.
Dr. Nina Agabian to lead research effort for Global Health Sciences Source: Joyce McKinney Dr. Haile Debas has named Nina Agabian, PhD, interim director of research for UCSF Global Health Sciences (GHS). In her new role, Agabian will have overall responsibility for setting the research agenda for GHS and will represent global health interests in campus wide and UC system wide research initiatives. GHS is mandated to integrate and coordinate global health activities across the UCSF campus and to develop collaborative initiatives with UC Berkeley. To fulfill this mandate in the area of research, Agabian will develop mechanisms to stimulate cross-disciplinary collaboration among UCSF and UCB researchers. A research committee representing all four UCSF schools and multiple disciplines will be appointed to develop, recommend, and prioritize research themes of relevance to global health. In addition, an annual series of research seminars will be launched that will bring together investigators who are looking at the same problem from the perspective of different disciplines. Haile Debas, executive director of GHS, notes that Dr. Agabians contribution to GHS will be significant and innovative as she brings together faculty from all schools to collaborate on research themes of compelling global health importance. Her exceptional skills as a basic scientist who has dedicated her career to the interdisciplinary study of microbial infections, and her experience working in several countries in Asia and Africa, make her particularly suitable to take on the leadership of research for GHS. At UCSF, Agabian is a professor in the departments of cell and tissue biology (School of Dentistry) and microbiology and immunology (School of Medicine). Dentistry Dean Charles Bertolami comments that Nina is an extraordinary scientist known for her interdisciplinary reach and accomplishment. Shes someone whose work and commitments have always had the highest relevance to global health, and so Im delighted that she will take on this new assignment. I can think of few people as well-prepared for this important leadership position. Dr. Agabians research focuses on the molecular and cellular biology of parasitism and mechanisms by which parasites cause chronic diseases. She currently directs the Oral AIDS Center in the School of Dentistry. Agabian came to UCSF in 1987 as director of the Intercampus Program in Molecular Parasitology. She has served as vice chair of the department of stomatology, chair of the division of oral biology, and chair of the executive committee of the graduate group in oral biology. CONTACT INFORMATION:
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