The Voice of Sint Maarten

It’s often difficult for a medical student to take time out of their schedule and work on projects in their community. Our free time is often encumbered with the “fire hose” of information that we all need to process and master before we sit for board exams. To be fair, there isn’t any free time per se. It is apparent (in medical school more than any other time I’ve known) that every minute of the time we schedule is, by choice, purposeful or not. With that noted, something exceptional happened this month in a span of three days that I am truly proud of. My “Z-Pack” Zika virus prevention initiative team all came together and tackled three extraordinary events around our Sint Maarten community.

If you’re just joining the Zika-related action, check out the background behind my work as well as some of the major accomplishments, achievements, and noteworthy lessons along the way this past year. My team’s work bridges a gap that exists between public health and the data we laboratorians acquire through diligent research.

The whirlwind of public health outreach events the Z-Pack was able to do were highly productive to the cause:

  • We have bolstered our public health and source reduction message on local radio, television, and print.
  • We have engaged and partnered with innumerable entities within this community and were an integral part of a mainstay annual health fair.
  • We engaged with local community members, not as students, but as public health liaisons fielding in-depth questions and addressing real concerns of the local population.
  • During these episodes, we were able to procure true data which we continue to collect, analyze, and use to formulate new approaches to positive health outcomes.

The first exciting development I listed was the debut into our media campaign. Being invited to the local radio to advertise our work and promote upcoming events was both exciting and reaffirming. In a short interview, I addressed Zika and other virus threats to the island community and discussed epidemiologic data and what it means in the scope of public health. Talking about our work alongside two of my team members and the project manager of the Ministry of Health’s vector control program was a thrill. A fellow team member and I were also fortunate enough to be flagged down by a local cable access television program to promote our work on a short video spot during our presence at the Lion’s Club Annual Health Fair I’ll discuss shortly. These media outlets reminded me of moments back in the laboratory when I had to present data clearly and field questions “on the fly.” Whether it was a staff meeting, educational resource assessment, or CAP inspection response, I couldn’t have been more prepared to handle the translational bridge from data to public view.

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Image 1: “Z-Pack” on the radio!

(Listen to the 16 minute radio spot here from PJD2 102.7FM/1300 AM The Voice of Sint Maarten)

I mentioned the Health Fair the local Lion’s Club sponsors each year, with booths that address a plethora of health education outlets from diet/nutrition, to diabetes, to (of course) mosquito reduction.  Partnering with our colleagues in the Ministry of Health we set up several tables in a tented booth and made available all kinds of educational resources for the public. There was a station designated to secondary interventions for combating mosquito risk reduction such as fogging guns and larvicides for standing water areas. I designed some clear-message flyers to distribute to patrons and others passing by our booth and was able to spark some interesting conversations with local community members and business owners who wanted more information—they wanted to distribute and display the same information in their offices and homes. Gaining popularity with the local community, we decided to record those interested parties and give them the title of “official community partners.” Not only will they feel more involved in the process of empowering and advocating for health for their community, but they will be motivated from within! I will say that my absolute favorite part of this health fair was the station our Ministry partners set up which included all their laboratory equipment they use to speciate, quantify, and analyze the local mosquito threat. This, alongside with our friends in local laboratory medicine who were collecting specimens to screen for Zika serologically, made this a very friendly environment for a laboratory professional like myself. You can bet I was happy to talk to visitors about epidemiology and risk reduction over a few microscopes!

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Figure 1: Clear-message informational flyers for public patrons to our booths at the health fair.
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Image 2: Health fair snapshots, a fogger gun, and some team building with microscopes.
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Figure 2: Preliminary data processing reveals an improvement in perceptions, attitudes, and behaviors toward Zika virus and overall arbovirus risk reduction.

On a more serious note, I want to speak briefly on the amazing opportunity that our community meeting offered for my team and I to learn some real truths about public health here on the island. With the success of partnering with laboratory services, research work in the field, and participating in a growing media campaign, the Z-Pack arranged a community meeting at a local religious center. Our “community meetings” as proposed in part from our earlier work focus on presenting audience and culturally specific information about reducing arbovirus risks and addressing health within the community. A community liaison connected us to a local Islamic center, where we conducted one of these meetings. Our presentation was received well, and a vigorous discussion followed. Having a partner from the Ministry of Health with us that day provided some clout to our discussions. I drew heavily on my interpersonal skills as a laboratorian when I fielded some really challenging questions from the adult crowd. Concerns in this particular community included specific objections to the effectiveness of the Ministry’s work on reducing mosquito populations, frustration over tourist-heavy areas receiving unfair attention, and true worry over improving health outcomes in a constructive and collaborative way. Taking the time to share their personal experiences was greatly appreciated by my team. Really engaging with the community on an individual level really makes it feel as though we are creating positive change. As a part of our work, data was collected on the effectiveness of our message. Still in its early stages, the data (Figure 4) shows qualitative improvements toward answers in post-presentation surveys which reflect new facts learned, potential for social/behavioral change, and establishment of health risk as a community priority.

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Social Accountability Inside and Outside the Laboratory

Being a medical laboratory scientist is more profession than occupation. Those of us who are affiliated with ASCP through our certification or work know the value of being part of an organization that values education, certification, and advocacy for patients. Finding a place in this network has given me a strong foundation through years of understanding a “best practices” paradigm. If you’ve been following my posts these last few months, you’ll have heard all about my work with Zika virus prevention and detection initiatives on the island country of Sint Maarten. Being here at the right time and right place have provided ample opportunity to flourish as a medical student with a history of laboratory experience. Recently, my school honored me with the Social Accountability Award and Scholarship for outstanding service during my time as a student with respect for my colleagues and the surrounding community of Sint Maarten. Having authored proposals and leading initiatives coalesced into an ongoing functional public health initiative, partnered with local government and NGOs. My experience as a certified scientist allowed me to build on three major ASCP foundations:

  1. Leadership. Receiving the award from the school validated my confidence in the work that I and my team have been doing this last year. Letters of recommendation came from my service-learning course director and Dean of Community Affairs, and the consultant advisor to the public health prevention office of the local Ministry of Health. The Dean of Medical Sciences even spoke about me with kind words and an inspired tone that really meant a lot to me, personally. This overall validation was not just for me—it was for the work, my team, and our efforts in local public health. The exercise in textbook-to-field informatics, education, and interventions could not have come to fruition without experiences I drew from in my lab years. Responding to CAP inspections, spearheading changes to SOPs or operations, and being a voice at the conference table taught me how to collaborate as well as lead.

 

  1. Education. If there’s anything I would say has been paramount in my time (both here in medical school and back in the lab) it’s the value of education. I could not do the work or pursue the projects I do today without backgrounds in molecular science, lab informatics, or general pathology and disease. Through numerous degrees and opportunities to work in the field of laboratory medicine, there are countless venues for someone to continue to patient care. My journey included a foundation of molecular biology, a graduate degree in lab science, an ASCP certificate with continuing maintenance as an MLS—now in post graduate work; I continue to work and learn in a dynamic environment. I have created SOPs from scratch, researched literature on seroprevalence and epidemiological statistics, managed and interpreted specimen collection and ELISA testing, and contributed to public health awareness and education. If you want diverse and exciting, this field has it! Education doesn’t stop with the degrees and certificates on the wall behind my desk, however. A very important, and arguably mandatory part, of being a scientist/clinician is being able to engage in an educational conversation with a wide variety of audiences. Talking about Zika virus prevention, seroprevalence, and risk mitigation is a different conversation with children, or local adults, or medical colleagues.
  1. Advocacy. Finally, I should say: if there’s one major thing professional organizations like the ASCP do for its members and our communities, it’s advocacy. Giving a concrete voice and substantial representation to the causes we care about as professionals yields positive returns for our overall shared goal of improved patient outcomes. My work here is first as a medical student, and second as a public health partner. Sharing and collaborating on how this community can best utilize its resources to address a local epidemic is at the forefront of my team’s work. When I started this project, I was inspired by the aims and goals of the Partners for Cancer Diagnosis and Treatment in Africa Initiative from the ASCP Foundation. I first heard about this at the annual meeting in Long Beach, and, as I prepared for my own stint overseas, I tried to keep that close to heart. Improving global health outcomes and increasing laboratory visibility were two of the major tenets of this project. Proudly, I would say I’ve been involved in both aims. Clear success has been documented (and continues to be seen!) in my Zika initiatives, and more and more people engage in conversations with me about translational medicine. With all my documents signed “C. Kanakis, MS, MLS (ASCP),” people have been surprised by all the things someone with “just a lab” background can really do! Breaking stereotypes and inspiring others to reach out for improving patient outcomes is all part of the same conversation I have with my community partners.

In short, my work with Zika virus prevention is an ongoing project, with new events and achievements tallied weekly. But before I get back to recounting the most successful events each month, I wanted to take a step back and say that I could not have been a Social Accountability Award recipient in this community without first learning the way to be a leader, educator, and advocate in our community.

Thanks for reading! Until next time…

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Diagnosing Displaced Populations

If you are at all aware of current politics, you are aware of the refugee crisis. The United Nations High Commissioner for Refugees Global Trends report estimates that 65.3 million people were displaced from their homes as refugees or internally displaced persons in 2015. Refugees are a population at risk for many diseases and health complications, and also lack access to adequate diagnostic testing. The average length of conflict-induced displacement is 17 years, resulting in significant healthcare ramifications. The health of refugees is important for obvious general humanitarian reasons, because the risk of spread to the host population when refugees find asylum, and for the burden untreated chronic diseases place on the healthcare systems of host countries.

The most common diseases in refugee camps are communicable, and include diarrheal disease, acute respiratory disease, measles, malaria, meningitis, TB, and HIV. Poor sanitary conditions and close accommodations are driving factors for these diseases. Loss of infrastructure in the country of origin increases the likelihood that a refugee will enter camp with a communicable disease. For example, disruption of vector control programs or efforts in a volatile country increase the risk of vector-borne diseases such as malaria. Breakdown of vaccine programs increases risk of vaccine-preventable diseases; the low vaccine rates in areas producing most of the world’s refugees contributes to the mortality of measles in refugee camps.

While there’s no denying that communicable diseases are a huge threat to refugee populations, non-communicable diseases (NCDs) are also a significant burden. In 2008, the WHO estimated 63% of deaths occurring globally were attributable to NCDs. The number is projected to increase to 55 million by 2030, with the most rapid rise expected to occur in developing countries – which are also the main source of displaced persons. Displaced persons are also more vulnerable to NCDs because of risks associated with population movements, including psychosocial disorders, reproductive health problems, higher newborn mortality, drug abuse, nutritional disorders, alcoholism and exposure to violence. Unfortunately, there is not much published on the incidence of NCDs in refugee populations, but at least two studies describe diabetes, hypertension, and seizure disorders are frequent diagnoses in refugee camps. A study of Congolese refugees found 9.5 cases of diabetes/100,000, 5.9 cases of seizure disorders/100,000, and 2.6 cases of diabetes/100,000. A Belgian study found a high number of refugees with chronic diseases and interrupted maintenance treatments in addition to those with diabetes, hypertension, and seizure disorders. Not diagnosing and managing non-communicable diseases in refugee populations increases the risk of morbidity and mortality in these populations, and means that the refugee will present a larger burden to the health system of the country in which the refugee finds asylum. Any loss of function due to an unmanaged NCD – loss of limbs from diabetic neuropathy, for example – will impact the future livelihood of a displaced person.

Increasing rates of antimicrobial resistance, of malaria and TB for example, make it even more important the that correct diagnosis – including pathogen strain where appropriate – is made before treatment is started. However, most health-related efforts in refugee populations focus on disease prevention and control, and less with building diagnostic capacity. The CDC Division of Global Migration and Quarantine (DGMQ) recommends testing refugees for infectious disease, especially those with long latency. Some of the diseases the DGMQ recommends testing for include malaria, TB, and intestinal parasites. There’s less guidance regarding testing for non-communicable diseases. The WHO recommends “ensuring the essential diagnostic equipment, core laboratory tests and medication for routine management of NCDs are available in the primary health care system”, with no further detail.

There’s very little in the peer-reviewed or even lay literature about the availability of laboratory diagnostics, but from what is available and anecdotally, diagnostics are often not at the forefront of medical efforts in refugee camps. The Belgian medical team consisted of 400+ volunteer medical staff, and yet was severely under-supported in terms of diagnostics.

Challenges to bringing laboratory diagnostics include infrastructure needs and cost. Unfortunately, lab diagnostics are not cheap! The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) spent $6.9 million USD to operate comprehensive labs in 124 of it’s 139 health facilities. Infrastructure needs – electricity and clean water –  and the need for trained personnel are common limitations to operating diagnostic laboratories in resource-poor settings such as refugee camps. Political instability also contributes to the challenge. In 2013, the DGMQ reported that the Dadaab refugee camp, home to over 300,000 refugees, had a fully functioning comprehensive laboratory. In May 2016, this camp was closed due to safety risks, eliminating the laboratory resource.

So what do we do? I have to be honest that – even though I thought I knew about this problem – writing this blog post has been eye-opening for me and I’m not sure I can answer the question. I’m definitely going to be thinking about this for some time. In the meantime, I think being aware of the problem of limited access to diagnostic laboratory testing in refugee populations is a good start. We need to get a better understanding of the scope of the problem. We should be ready and able to provide specific recommendations for meeting diagnostic needs in these populations including most appropriate diagnostics given clinical needs, infrastructure, and available treatment options. The road toward a solution will include global collaboration, research, and advocacy.

 

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Sarah Riley, PhD, DABCC, is passionate about bringing the lab out of the basement and into the forefront of global health.  

IRBs and Public Health Pathology

Hello again! Welcome back to my latest check-in following my progress with Zika risk reduction and public health outreach. Partnering with the Sint Maarten Ministry of Health through my medical school has provided amazing resources to take a look at social determinants of risk under the purview of public health, integrating both medical sciences and community service.

Early on in this project, I discussed the early stages in conceiving and planning these public health works in my first post “An Arbovirus Abroad.” This of course seemed like the perfect name for the proposal my team and I authored at the end of our first semester together. Done under an elective service credit, our full Internal Review Board (IRB) proposal for research within the community was called “An Arbovirus Abroad: a Service Learning Project Exploring Public Health Outreach, Social Determinants of Health, and Partnerships with Local Government to Address Zika Virus Knowledge and Community Outcomes.” The goals were to strengthen our partnership with local government offices as we aligned our efforts with reducing infectious risk and addressing community knowledge and attitudes regarding Zika.

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Figure 1. Title Page of original IRB/Research Project Proposal under G. Jackson, Ph.D., Assistant Dean, Community Affairs and Service Learning at AUC School of Medicine

After we secured IRB approval, we began work quickly. Holding meetings with the Ministry’s representative consultant for their office of Collective Prevention Services (i.e. vector control) and scheduling the remaining work for the semester. With five new members of the “Z-Pack” we established a loose timeline with our advisor. Our new goal: integrate what we learned last semester and bring it to a conclusive change within the community.

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Figure 2. Title card from initial briefing meeting with members of the Z-Pack, including coordinating partner from the Ministry of Health (CPS office) Mr. G. Davelaar.

This integration of knowledge from literature review/research, evidence-based best practices, and forward moving progress are all things those of us in the medical laboratory profession are quite familiar with. Getting IRB approval for a lab-centric project is quite involved and requires meticulous proof and substantial support to posit any claim to the benefit/risk ratio involved with human or animal subjects. I remember from my own graduate and undergraduate research that without heaps of evidence, you will be hard pressed to continue in any direction. While public health is a different science, the basis on evidence-based research is still present. During our initial assessments, literature reviews, and brainstorming, the “Z-Pack” went through hundreds of scientific articles covering everything from infection control precedents, to social behavioral change, and even the use of media and fear to illicit change.

Laboratory scientists know the impact of their work, though it may not always be the most evident to the general public. The near 70% of diagnostic information that comes from our work, and the virtual entirety of neoplastic diagnoses rely heavily on our training, skill, and certified competency in evidence-based practices. ASCP has a long-standing mission of advocacy for patients in the way its members and affiliates represent the profession at large. I believe that having those years of experience under my belt and those letters behind my name give me a head start when executing translational research. Going from raw data, analyzing it, and bringing it to life is something we all inherently train to do—and do well!

So, up to date, my team has secured two measures to contribute to our research. First, we gave an educational presentation to a community after-school program in one of Sint Maarten’s endemic regions. We had tailored a wonderful presentation I discussed in a previous post which caught the eye of the Ministry of Health and has spread to numerous places around the island under their sponsorship. With the same success, we managed to reach school-aged children in an engaging way about Zika, their health, and source reduction. Our second event is slated for this weekend where we have partnered with the Muslim student-interest group (MSA) on campus to go with them on their routine visit to a local mosque on a school-sponsored student service day we call “Community Action Day.” While the MSA students engage with their local community, the “Z-Pack” will conduct a two-part effort: to conduct a grounds-inspection for source/vector control around the mosque, and deliver a presentation for both children and adults regarding Zika prevention behavior.

How do those two events connect with my theme of evidence-based lab scientists? Well, one of my engagements when at Northwestern Medicine was to teach a course discussing transfusion protocols and laboratory information to clinical nursing staff. Presenting information, or teaching people, new ways to think about their environment at work or home is a part of being interdisciplinary. I was able to speak with medical jargon to the clinical staff, but with the children I have to use my ability in translating medical knowledge to understandable facts while also keeping the audience interested. My team proved in our last school-aged project, that when children are engaged and enthusiastic about something they have learned, they will take those messages home with them and hopefully contribute to a positive outcome. As for the second example, what could be more directly appropriate for lab folks to understand here: a surprise inspection! Sure, no one’s losing any accreditation points here, but the fact remains that we all have experience from one side or another making sure that things are up to code on pre-determined conditions and protocols. We have an SOP from the Ministry regarding the items of inspections as they relate to source control, so translating them to a new site should prove interesting.

I’ll close this post off with an interesting piece recently posted by Ms. Susan M. Lehman, MA, MT (ASCP)SM where she discussed learner (i.e. student) experiences. She talked briefly about how online curriculums and other lab-skills courses may rely on more independent learning, changing the expectations of students. One of her students summarized it positively saying, “you get what you put into it.” That’s what I think about the service elective my work is associated with. It could be simple directed readings with great discussions, but what my “Z-Pack” team has and the skills we each bring to it have made the project and its partnerships exciting.

Thanks for reading!

 

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Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Silent and Deadly

This post was intended to be about mosquito borne diseases. But, as I look out my window at an ice-encrusted landscape, I found it difficult to concentrate on tropical diseases. Instead, I started thinking of public health issues that are commonly associated with cold weather. What came immediately to mind was carbon monoxide poisoning.

Carbon monoxide poisoning accounts for nearly half of all fatal poisonings in many countries (1). Each year, 430 people in the U.S. die from CO poisoning, and 50,000 visit emergency rooms for treatment of CO exposure.  CO is odorless, colorless, tasteless, and absorbed rapidly through the lungs. CO is produced during endogenously during respiratory metabolism, and as a product of combustion of carbon containing fuels. Thus, CO exposure can occur when using fuel burning heaters in enclosed areas. Examples include kerosene or propane burning generators, stoves, lanterns, gas ranges, and burning charcoal and wood. The majority of CO poisonings in most countries occur in the fall and winter, when people seek means of heating their homes.

CO toxicity is caused by the formation of carboxyhemoglobin (COHb). CO binds to hemoglobin with an affinity approximately 200 times that of oxygen. COHb causes a left shift in the oxyhemoglobin dissociation curve, so that less oxygen is delivered to tissues at a specific partial pressure of oxygen. Clinical manifestations of CO poisoning are due to hypoxia and progress as the COHb% increases. Symptoms include: headache (1-10% COHb), dizziness and nausea, syncope, elevated pulse and respirations, coma, seizures, and death (70-80% COHb).

COHb should be promptly measured when CO exposure or toxicity is suspected. The proper specimen for COHb measurement is arterial or venous whole blood. The primary laboratory method for measuring COHb is spectrophotometry with CO-oximetry, which uses several wavelengths to differentiate hemoglobin, reduced hemoglobin, and dyshemoglobins. It is not recommended to use pulse oximetry to measure COHb, as this method does not have the capacity to resolve oxy-hemoglobin and COHb. In fact, patients presenting with respiratory distress in spite of normal oxygen saturation should be evaluated for COHb. Blood COHb concentrations in healthy nonsmokers is 1-2%, and in smokers the normal concentrations are 5-10%. The clinically actionable concentrations are >10% (Goldfrank’s). CO poisoning is treated with the administration of normobaric oxygen. Severe cases are sometimes treated with hyperbaric oxygen therapy (2).

The incidence of CO poisoning in the US is likely to be underestimated due to under-reporting. The Council of State and Territorial Epidemiologists issued a statement proposing the inclusion of CO poisoning in standard health reporting. CSTE criteria for case ascertainment include both clinical criteria (headache, dizziness and nausea, elevated respirations, coma, death) and laboratory criteria (COHb > 5.0%).

But, CO poisoning doesn’t just occur in the cold months. Certain occupations (like auto mechanics, taxi drivers, and bus drivers) are at increased risk for harmful CO exposure. For example, CO poisoning ended the career of NASCAR driver Rick Mast. Neither is CO poisoning a problem limited to industrial countries. Developing countries also have CO exposures that are under-reported to an even greater degree than the incidence in the US. A common source of CO exposure in developing countries is indoor air pollution from cooking over coal fires. Environmental exposures occur from the use of diesel engines in vehicles and generators, compounded by the lack of emissions controls and standards. Not only do we not know the incidence of CO toxicity in developing countries, we don’t know that much about the pathology of chronic exposure to CO. Suggested impact includes neurological damage that may or may not be reversible, and cardiac damage caused by myocardial ischemia. Portable electrochemical devices that can be used to measure CO in the field. Measuring CO concentrations in different environments such indoor cooking areas and street corners (see picture), as well as screening for CO poisoning in developing countries could help us better understand the degrees of exposure and the physiological impact of these exposures.

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Dr. Joe Steensma of Washington University Brown School of Social Work and research assistants from Universite Publique du Nord (Cap-Haitien, Haiti) read results from a portable carbon monoxide monitor that was placed in a home in Petit-Anse, Haiti.

References

  1. Raub et al. Carbon monoxide poisoning – a public health perspective. Toxicology 2000; 145:1-14.
  2. Weaver et al. Hyperbaric oxygen for acute carbon monoxide poisoning. NEJM 2002; 347: 1057-1067.

 

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Sarah Riley, PhD, DABCC, is passionate about bringing the lab out of the basement and into the forefront of global health.  

Laboratory Data and Global Health Security

Hello! If you’ve been following my posts these last few months you’ve seen my work here in the country of Sint Maarten regarding the Zika virus outbreak. I have been very fortunate to be involved at various levels of work with this new epidemic from lab testing and seroprevalence research to public health and policy initiatives. As 2016 comes to a close, I would like to celebrate that work by highlighting a few great milestones here and offer a few thoughts for the future starting next year.

I mentioned before that immunological lab testing has been ongoing, targeting IgM and IgG seroprevalence of Zika virus (along with other Arboviruses i.e. West Nile, Chikungunya, Dengue, and Yellow Fever etc) within the community around my medical school. Nearly two hundred samples later—and counting—the results point to a presence of nearly 10-15% of people are confirmed positive for an active (IgM) or resolved (IgG) infection with Zika. Despite the small sample size and ever-developing data sets, these numbers are highly suggestive of a correlation mimicking that presented to us by the Ministry of Health (see my Zika virus primer post from October of this year). This holds promise for future studies like these which depend heavily on that type of medical laboratory science and analytics. My involvement in the seroprevalence project has been very rewarding and I have been able to contribute my experience and skills as a laboratory professional in writing SOPs/protocols, ensuring proper laboratory safety, and highlighting specimen collection standards. With several years as a medical laboratory scientist, I have been lucky to find a place to do such good work. The opportunity to step up as a leader when it comes to laboratory skills is always fulfilling!

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Figure 1: Seroprevalence research and testing publicity for the AUC campus community, collection and specimen processing. photo credit: A. Yancone, 2016.

Along with the success of the lab-driven research at school, the project I spend the most time with is aimed at public health. My last post highlighted some of the successes my team and I have had with creating and maintaining a good relationship between members of the local Ministry of Health and the school system. In February earlier this year, my school strengthened their partnership with the Ministry by establishing a mission of public health initiatives driven by students and faculty who were engaged in community affairs, service learning, and public health. This increased sustainability will surely create a more long-lived effort for translational research to have an impact on health. I couldn’t be prouder of the work my team has done to show the community that medical students here represent the very best ASCP qualities of advocacy, partnership, and outreach through science and education. It is an honor to have my contributions recognized by the local public health officials—even moreso when they have now incorporated and sponsored my teams’ message of vector control and source reduction to schools across the island. Having children aged 4-16 enthusiastically repeat back to us and representatives from the Ministry they would “throw standing water away!” made a strong impact on public health officials, students, and their parents/families. Setting goals for the community’s health metrics are supported by local epidemiologic data and pushed forward by policy initiatives, and always rooted in diagnostics and laboratory-confirmed cases. This means that all of our efforts, all of my presentations, and each step along the way holds a foundation in laboratory science and continues to motivate me as we continue forward. We all know the lab-week tag line that “nearly 70% of a patient’s chart is lab-data-driven,” and I can attest that for issues in public health and policy the same if not more applies!

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Figure 2: American University School of Medicine Partners with Sint Maarten Ministry of Health, Social Development, and Labour to bolster public health efforts and community involvement. AUC 2016.

Last month, Sint Maarten’s Ministry of Health sent Dr. Virginia Asin, the section director of the Collective Prevention Services office, to a Global Health Security Meeting in Miami. In this meeting she presented the policy initiatives her country had in dealing with risk reduction in the Caribbean. As a leader in this field, she cited ongoing partnerships with NGOs, public health offices, and medical professionals. She also shared her strong support for a project she said was truly a foundation for success—my team’s public health outreach! Dr. Asin and other staff members from the Ministry were present at an end-of-the-quarter presentation and meeting regarding this community outreach work based from the school. She shared with us her thoughtful admiration and ongoing support for the work we do here and said she was proud to have us as colleagues. Strong words and poignant sentiment from a real public health physician working in the field. It is incredible to have these efforts noticed by the Global Health Security Agenda (GHSA)! The GHSA exists at the forefront of the CDCs efforts to address the spread of various diseases, the global preparedness for them, and their economic impact on the global community. Dr. Asin and the Ministry’s continued support continue to inspire me, as well as other students, to look toward the future in creating more opportunities to merge medicine, data analytics, and positive outcomes.

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Figure 3: Global Health Security Agenda platforms. GHSA and the CDC 2016.

Slated to begin in January of next year, my team will begin conducting a new project aimed at improving local health literacy and source reduction. Under our IRB proposals, we hope to gather the data about the residents of this island and subsequently match them with correlated health statistics (i.e. confirmed/reported Zika cases) and actively engage with the Ministry in improving these numbers. With this current momentum, I would argue that even though a few successful highlights have come, the best is yet to come. If I have learned anything during my time as a medical laboratory scientist, there is a certain exciting progress to the dynamic way data is being used as we move forward. Breakthroughs in communication and analysis are allowing these advancements to take off: ASCP pathologists consulting on cases of chronic diseases in Africa, growing credibility surrounds our profession as our voice accomplishes great things in Washington, and advancing diagnostics are getting more efficient every day. Hopefully, projects like the ones I keep all of you updated on will continue to strengthen the connections between the labs, media, and public health officials as we continue to improve outcomes globally.

Until next time! Happy Holidays and Have a Happy New Year!

(…and don’t keep standing water around if you live in a warmer area, because…vector control!)

 

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-Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.

Healthy Me

Hello again! Last month, I wrote a primer on my experiences working in the realms of public health while in medical school. I am proud to have an active role in leading some Zika virus-related research and outreach while here in the country of Sint Maarten.

I left off last time with a photo of our most current successful partnership with local government and the local Red Cross where we organized student volunteers to do home inspections and contribute to vector control efforts. Our contributions were praised and are ongoing as more students volunteer for tangible public health working experience in the field. Concurrent with another research project happening on campus regarding Zika seroprevalence, the school community is excited and engaged in all of these efforts. Though it is early now, by the next phase of that project I will be sharing how immunologic work aimed at Zika detection is done here and how labs—everywhere—are absolutely vital.

Relying on epidemiologic and laboratory data has shaped the way we look at Zika virus in this area. A vast spike in reported cases to public health offices matched with an equal increase in laboratory confirmed cases has raised alarm for local officials. While the increased ability to detect and report Zika within the community is growing due to advancing research, the measures taken to mitigate the risks of infection and transmission have not changed despite public health efforts already. With the history of Arbovirus being a routine part of life in the region, behavioral change seems to be a significant hurdle with respect to social determinants of health.

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Figure 1. Distribution of cases on Sint Maarten per epidemiologic year 2015-2016, per the Ministry of Health, Social Development, and Labor – Collective Prevention Services Department.

For now, working partnerships have grown in the last month and have brought on exciting developments. Incorporating the public health outreach within the oversight of a service-learning course at AUC School of Medicine, ongoing works related to Zika education and prevention are supported by local government. The Sint Maarten Ministry of Health, Social Development, and Labour as well as their office of Collective Prevention Services were impressed with my team’s initiative and so enthusiastic about our first public health effort that they wanted to be a involved with our work. Having such prominent sponsors is lending both credibility and attention. The relationship that has developed between the mobilized student volunteers has fostered an attitude of inclusivity and collaboration.

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Figure 2. Representative meeting of student volunteers, Sint Maarten Red Cross, and others at a briefing of the Collective Prevention Services training session, October 2016.

One of the more recent and successes involved a program aimed at school children from various parts of the island. Local churches here have a program called “Healthy Me” where by school-aged children between 4 – 16 from various regions within the Sint Maarten community come to one school or community center to learn about their own health. Often times, my medical school’s pediatric interest group will send a large number of volunteers to talk to the children about metrics of health including conducting eye exams, measuring height and weight, blood pressure, pulse, and discussing diet. This time, my team proposed we collaborate with this event and hold Zika related presentations in one of the classrooms adjacent to those other screening rooms. We were approved and held nearly ten sessions with a total of almost 400 children!

Having a youth-tailored presentation along with coloring-activity books, we were able to impart a strong message to the children regarding source reduction and vector control. Writing an age appropriate presentation, engaging the children with active participation, and distributing activity booklets modeled after CDC education materials received positive feedback. Our community partners with Collective Prevention Services at the Ministry of Health supplied their overwhelming support and truly enjoyed being a part of the project. They have since requested to use our presentation materials and activity books at schools throughout Sint Maarten with the hopes of contributing positive public health outcomes from children to their parents and families.

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Figure 3. Me delivering one of the Healthy Me presentations to children, October 2016.

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Figure 4. Healthy Me Zika Presentation.

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Figure 5. Pamphlets for Children.

Citing the CDC’s approach to similar Arbovirus threats in the past, it became clear to my team and I that behavioral change is a significant part of improving public health outcomes within a community. A grassroots, or “bottom up” approach, both involves the community and positively influences behavioral changes to reduce risk and transmission. While the region here is fraught with historical exposure to Arbovirus threats, awareness and risk reduction are still critical for a population’s overall health.

Recently, the WHO released a statement calling for Zika to no longer be considered an epidemiologic emergency. This news has been met with both relief and criticism. Despite the virus receiving this downgrade, they still assert that it will continue to pose a threat as an ongoing infectious agent with complications that must be monitored by public health officials. While cases continue to increase over time, the management and reduction of risk is something both laboratories and public health officials will continue to address. Regardless of its status as an emergent epidemic or not, laboratories will still conduct studies to confirm reported cases, local government will continue to address the residents of this island to reduce risk, and I will continue to report about the state of progress between them. Labs, public health, and media are all part of the mechanism which translates data into results—and I am happy to be a part of that process.

Thanks for reading!

References

1. Vlaun, N., & Davelaar, G. (2016). ZIKA Virus on Sint Maarten . Philipsburg, Sint Maarten: Ministry of Public Health Social Development and Labour, Collective Prevention Services.

2. Davelaar, G. (2016). Results of the Pilot project “Cull de Sac,” a Mosquito Surveillance Plan for Sint Maarten . Philipsburg, Sint Maarten: Ministry of Health Social Development and Labor, Collective Prevention Services.

3. Gubler, D. J. (1988, December 7). Aedes Aegypti and Aedes Aegypti-borne Disease Control in the 1990s: Top Down or Bottom Up. Washington, DC: Centers for Disease Control and Prevention.

4. WHO (2016). “Fifth meeting of the Emergency Committee under the International Health Regulations (2005) regarding microcephaly, other neurological disorders and Zika virus” Statement, 18 November 2016. http://www.who.int/mediacentre/news/statements/2016/zika-fifth-ec/en/

 

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-Constantine E. Kanakis MSc, MLS (ASCP)CM graduated from Loyola University Chicago with a BS in Molecular Biology and Bioethics and then Rush University with an MS in Medical Laboratory Science. He is currently a medical student at the American University of the Caribbean and actively involved with local public health.