Category: World health

Cholangiocarcinoma: What is it and why is it so prevalent In Thailand?

By Imperial medical students Thomas Hughes and Thomas O’Connor 

Today, 17th February 2016, marks the first ever World Cholangiocarcinoma Day.

Cholangiocarcinoma (CCA) is a primary liver cancer, usually formed from glandular structures in the epithelial tissue (adenocarcinomatous). It occurs in the bile ducts and is classed as being either intra-hepatic (IHCC) or extra-hepatic (EHCC) depending on whether the tumour forms inside or outside of the liver.

CCA is the second most common form of primary hepatic malignancies in the world, with survival beyond a year of diagnosis being <5%.[1] It represents 30% of primary hepatic malignancies with a mean survival rate of 3-6 months after diagnosis, due mostly to the late presentation of symptoms which massively reduces treatment success rates.[2],[3] In the western world the causes of CCA are not well known with 80% of cases being random with no specific risk factor. Despite this, several associations have led to risk factors being identified. The majority of risk factors are associated with chronic biliary inflammation, the most common of which is primary sclerosing cholangitis. The human pathogen Cryptosporidiosis has been associated with CCA and typhoid carriers have been found to have a six-fold increase in CCA. Aside from this, hepatitis B and C have both been found in higher proportions in the CCA population.

CCA is much more prevalent in south-east Asia, particularly north-east Thailand, than elsewhere in the world, with 80-90 cases per 100,000 people.1 The reason for the high incidence is due to biliary infestation with liver flukes, most notably Opisthorchis Viverrini (OV). OV has been recognised as a type 1 carcinogen since 1994 due to its role in causing inflammation of the bile ducts which leads to fibrogenesis and increasing tumorigenesis.3Oxidative stress has been proven to play a key role in transforming a chronic OV infection into CCA via advanced periductal fibrosis.4 OV makes it’s way into the human body via the consumption of raw or undercooked fish, a delicacy in Thailand, particularly in the Isaan region. (more…)

Introducing HarvardX’s Massive Open Online Course (MOOC): Practical Improvement Science in Healthcare: A Roadmap for Getting Results

Developed through a collaboration between HarvardX and the Institute for Healthcare Improvement, ‘Practical Improvement Science in Health Care: A roadmap for getting results’ is a free online course, which starts 20th January and lasts for 6 weeks.  It aims to provide learners with the valuable skills and simple, well-tested tools they need to translate promising innovations or evidence into practice.

Learners will dive into short, engaging lectures and have access to additional materials and resources. They also will have full access to the social network provided by the edX platform, which provides immediate peer-to-peer feedback and facilitates shared learning.

The course is designed so that learners will begin building and applying basic practical improvement skills right away, regardless of their role in health or health care, and regardless of previous improvement experience.

At the end of the course, participants with grades above a certain threshold are able to purchase a certificate of completion or proof of continuing education credits.

IGHI’s Director Professor the Lord Ara Darzi tells us more in the short video above.

To review the course website and sign up, visit their website https://www.edx.org/course/ph556x-practical-improvement-science-harvardx-ph556x

Part 4: The future of Universal Health Coverage and how we can achieve it globally

To mark Universal Health Coverage Day on 12th December, we interviewed former CEO of the NHS and Adjunct Professor at IGHI, Sir David Nicholson.

Universal health coverage (UHC) improves how health care is financed and delivered – so it is more accessible, more equitable and more effective.

In the final video of our series below, Sir David talks about how the key to obtaining and maintaining UHC across the world is to get the support required from leadership and politicians in order to make it happen.

He provides examples of countries that are already working towards UHC and addresses how IGHI are contributing towards the UHC system in order to make quality and safe healthcare a reality for all.  This includes our work for the World Innovation Summit for Health (WISH) forum on Universal Health Coverage, of which Sir David was chair.  The WISH report ‘Delivering Universal Health Coverage: A guide for policy makers’ focuses on how to create a robust, yet accessible framework laying out the key questions that senior policymakers should consider when attempting the implementation of UHC.

IGHI’s work on frugal innovation also allows us to work on low cost, high impact innovations which can be distributed globally and are affordable to all.

Get involved 

To get involved or find out more about Universal Health Coverage Day, visit their website.

Photographs that change the world


student-challenges-competition-2015-168By Student Challenges Audience Choice Award winners Jacob Levi, Amanda Stenbaek and Hiba Saleem-Danish

In Feb 2015, we took part in the IGHI Student Challenges competition and won the 3rd place prize of £1000, towards our Photovoice App Development Project.

Photovoice is a research method, which is already in use globally, whereby photographic data is collected and analyzed in order to gain insight into various health, social or community problems. Currently, the methodology is inefficient and expensive. Cameras are distributed to communities in and they’re asked to capture images, which depict a problem in their life, however, our concept was to modernize and improve the Photovoice methodology in a digital age. At the time of the competition, our concept was very new, exciting and flexible. We wanted to make a mobile application to store and take the photos. Since then, we have done some follow up research with users of Photovoice and to make our service more useable. We have rebranded our service to create: My Vupoint – a mobile responsive website, which is the first stage of our vision. (more…)

Celebrating the first ever Universal Health Coverage Day: 12.12.14

uhc-day-badge-enToday, the Institute of Global Health Innovation (IGHI) will join 500+ organisations around the world to launch the first-ever Universal Health Coverage Day. This historic coalition will mark the anniversary of a landmark UN resolution urging all countries to provide universal access to healthcare without financial hardship.

We believe that no one should fall into poverty because they get sick and need healthcare. Universal health coverage (UHC) is essential for making progress against challenges like HIV, cancer, Ebola, dementia, diabetes and mental health issues – and for creating a fairer, more resilient society.

Universal healthcare coverage is one of the seven forums at 2015’s World Innovation Summit for Health (WISH), which takes place in Doha from 17-18th February and launched by the Qatar Foundation. (more…)

Raising awareness about female genital mutilation: What can we do to help?

By Sunila Prasad, Imperial Hub

guest speaker
Guest speaker Ms Hoda Ali

On 16th October, Imperial Hub hosted its inaugural talk of The Challenge Series – a series of seminars aiming to inform students on key issues.

Imperial Hub was honoured to host special guest speaker and FGM survivor, Ms Hoda Ali, and Honorary Clinical Senior Lecturer at Imperial, Dr Naomi Low-Beer, to offer their insights into the increasingly prevalent issue of female genital mutilation (FGM).

With Hoda as the first speaker, the audience was immediately immersed into the world of FGM through the perspective of a survivor. Having experienced FGM at the age of 7 in her native Somalia and then forced to flee her war-torn country, she finally settled in the UK to work as a sexual health nurse and FGM campaigner. Hoda’s story was inspirational, and she went on to explain the devastating impact FGM can have on a victim both physically and mentally and how she survived it. (more…)

Moving from global heath 3.0 to global health 4.0

Richard Smith of the UnitedHealth Chronic Disease Initiative and Adjunct Professor at IGHI talks about our NCD event at the Royal Society on 4th October and how we can make progress in global health as a whole.

MAF East DRCGlobal health 1.0 was called tropical medicine and was primarily concerned with keeping white men alive in the tropics. Global health 2.0 was called international health and comprised clever people in rich countries doing something to help people in poor countries. It had Cold War overtones. Global health 3.0, which is still the main manifestation of global health, is about researchers from rich countries leading research programmes in poor countries. But global health 4.0, increasingly the present and certainly the future, is research and other activities being led by researchers from low and middle income countries.

The 11 UnitedHealth/National Heart, Lung, and Blood Institute (NHLBI) centres are an example of global health 4.0 in that all the centres are led by researchers from low and middle income countries and work on programmes directly relevant to the problems in the countries. Dorairaj Prabhakaran, who is the leader of the New Delhi centre and chair of the committee of the leaders of the centres, told last week’s meeting at the Royal Society about the four phases of global health.

As Prabhakaran made clear, the concept came from Peter Piot, who is now the director of the London School of Hygiene and Tropical Medicine. Piot identified other differences between global health 3.0 and 4.0. Global health 3.0 is conducted mostly in sites and is largely biomedical and concerned mostly with infectious disease. In contrast, global health 4.0 is conducted in multidisciplinary centres and covers broader health issues, including NCD and disparities. Global health 3.0 uses predominantly the methods of epidemiology, including clinical trials, while 4.0 employs a much wider spectrum of methods through from discovery to implementation science.

IMG_0109
The speakers at the event from the 11 centres

The centres presenting at the Royal Society fit closely with these other aspects of global health 3.0. The research is about reducing the burden of NCD, and the work ranges from interventions to make whole communities healthier through primary care programmes to prevent NCD to projects to improve the care of those with established disease. There is also policy research, and the centres work on advise governments and help draft legislation. (more…)

Richard Smith: “I’m the minister of health in a poor country”

Richard Smith of UnitedHealth and Adjunct Professor at IGHI, writes for the BMJ about our upcoming NCD event at the Royal Society on 4th October.  

Richard_SmithI’m the minister of health in a poor country. Until last year I was a urologist. I was the president’s urologist and took out his prostate. To be honest, I don’t think it needed to come out, but he insisted. You don’t resist the president. He was delighted with the result and rewarded me by making me minister of health.

It doesn’t feel like a reward. Everybody wants something from me, but I’m very low in the hierarchy. I don’t think that the minister of finance even knows who I am. When I talk about the dangers of tobacco, he smiles at me as if I’m a child who doesn’t know what he’s talking about.

What should be my priorities? That’s my big problem.

The president, who doesn’t now have a lot of time for me, tells me to reduce deaths, but not to spend any more money. He doesn’t seem to care how I reduce deaths (or even whether I do) so long as I don’t spend more money.

Other ministers mostly ignore me, unless their prostates are playing up. The minister of finance sends an official every month to make sure I’m keeping to my ludicrously small budget. The official never smiles.

Old colleagues from medical school tell me that the teaching hospital needs a lot more money. They want to expand neurosurgery, oncology, and the dialysis programme. They also want to start transplants and cardiac surgery for children. One of the professors in the medical school is trying to start a biobank and stem cell research. He talks about the unique genetic profile of our population.

Even though I’m a urologist, I feel that achieving the MDGs should be my priority. We’re not doing badly with reducing child deaths, although I know that in the remote area that I come from deaths are just as common as they were 10 years ago. The reductions have happened elsewhere.

100015But we’re not doing well with reducing maternal deaths. All the religious leaders oppose family planning. I daren’t tell them (or anybody) that I’m an atheist. There are no obstetricians in the rural areas. They make too much money in the capital, and where would their children go to school if they were in the bush? But they won’t allow non-doctors to do Caesarean sections, and they won’t work with traditional birth attendants. They’re witchdoctors, they tell me. Whenever I try to persuade them to allow non-doctors to do Caesareans or to work with traditional birth attendants they run to the newspapers and talk about “second class care for second class people.” (more…)