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T.I.G.R.E.Trans‐disciplinary Immersion in Global
Health Education and Research
Julie M. Herlihy MD MPHDirector Pediatric Global HealthAssistant Professor of Pediatrics
UCDavisApril 2, 2016
Evan Bloch, MBChB, MD, MS, Mary Lynch, RN, MS, MPH, PNP‐BC, FAANLing Zhan, DDS, PhD, Tina Brock, BSPharm, MS, EdD, Eva Harris PhD, David Lopez‐Carr PhD,
Poonam Patel, Arup Roy‐Burman, MD Pediatrics, UCSF
ROATÁN, HONDURAS
POPULATION: 25,000 (2001) 109,000 (2014)VISITORS/YEAR: 900 (1970) 100,000 (2000) 1 mill. (2014)
Infant Mortality 79/1,000 (on island), 19/1,000 (national)Breastfeeding rates low ~32% EBF < 6 month
Honduran Census 2001, 2014; DHS 2005, 2011‐12 Secretaría de Salud [Honduras] IN de E (INE) e II. ENDESA Encuesta Nacional de Demografia y Salud 2011‐2012.
How do you transition from clinical service delivery to research?
How do you build a viable consortium of partners?
T.I.G.R.E
• Trans‐disciplinary• Immersion
• Global Health
• Research &• Education
Population Health Research
Beyond Pediatrics
Local Leaders
TRUST
Clinical Partnership• RoatánVolunteer Pediatric Clinic
Bilateral Capacity Building• Global Healing Fellows (5)
Expansion of Services/Training• Dental• Nursing• Pharmacy
Mentored Research• Dengue Epi
• Perinatal mobile health
• Geo‐spatial Mapping
• ZIKA
2003
2006
20082014
Roatán Public Hospital –Partnership
• Global Healing Pediatric Volunteer Clinic• Dra. Cerritos – Director, On‐site Mentor• >30,000 pediatric visits (2003‐2014)• RVP Volunteers >250• Pediatric Residents n > 100• H.E.A.L. Undergrads (UCSF/Stanford) n=80
Mentored Research• Issue identified by local leadership• Team of mentee/mentors defined• Weekly team status call + field report• UC Reliance for IRB approval + local IRB• Mentee Pool: Residents, Professional Students, GH Graduate Students, Honduran Interns, Honduran Graduate Students
Strengthening Babies through Mobile Health
• Formative Qualitative Research• Intervention/Methods:
– Medic Mobile delivers 80+ evidence‐based SMS + animation to address known factors for BF cessation
– Pre/post Design (n=880)• Outcome: EBF at 2*, 4, 6 month• Team:
– Mentors: UCD Faculty (2) UCSF (1), Dra. Cerritos– Mentees: UCSF GHS Masters Students(2),UCD Pediatric Residents, UTH Psychology Students
Dengue, Chikungunya or Zika??• Clinical Perception of Dengue vs. PCR
– Dengue, Chikungunya– ZIKA, ZIKA
• Case‐control cohort of pregnant women/infants to explore Zika natural history (NIH R21 Application)
• Mentors: UCSF, UC Berkeley, Johns Hopkins• Mentees: Doris Duke Fellow /UCSF Medical Student, Honduran Interns
Tuholske, C. et al, (Article Pre‐Print) Anthropomorphic impacts on Roatán, Honduras: 30 Years of Land‐Cover and Land‐Use Change. Plurimondi. An International Forum for Research and Debate on Human Settlements. (7) 15, 1‐7.
Valuable Lessons• Need champions at each campus and locally• Research takes time and communication• Define consortium leadership• Trainee deliverables vary• Flexibility
Julie Herlihy MD MPHCaroline Chantry MD
Jihey Yuk MDLisa Rasmussen MD
David Lopez‐Carr PhDCascade Tuholske
Eva Harris PhDKaren Sokal‐Guiterrez
MD MPH
Arup Roy‐Burman MDShiela Jenkins MD
Mary Lynch, NP, MS, MPHLing Zhan, DDS, PhD Tina Brock, MS, EdD
Poonam PatelDaniela BrisettTrevor Brooks
Lyolya Hovhannisyan
John Donnelly PhDSara Fernández PhDCarla Cerritos MD
Our Partners:Roatán Public Hospital
Ministry of Health HondurasHonduran Red Cross
Evan Bloch MBChB, MD, MS
ACKNOWLEDGEMENTS