Blog posts

Putting TB to the test: My journey so far

By Harriet Gliddon, winner of the IGHI Student Challenges Competition 2015-16

ANT_4401During March 2016, I blogged for IGHI on World TB Day about my experiences of entering the Student Challenges Competition.

The intervening six months have been busier than I could have imagined, and filled with things like delivering an invited talk at the Biosensors Summit in Sweden, submitting my PhD thesis and completing an internship at the World Health Organization.

Despite the chaos, I’ve managed to make some exciting advances with the nanomaterial-based diagnostic test for TB that I presented at the Student Challenges Competition. One component of this work has focused on validating the genetic markers that are the biological targets, or biomarkers, of the test. I have used various methods, some well established and others more experimental, to assess the reliability of the biomarkers in discriminating between patients with and without TB. As I said in March, this work is a real team effort and a large proportion of the analysis was conducted by Dr Myrsini Kaforou, who I’m very grateful to. The biomarkers validated extremely well across multiple platforms, which proves their robustness regardless of the HIV infection status of patients, and across geographical locations (Malawi and South Africa), showing that they’re robust and reproducible for use as diagnostic markers of TB. This work is currently being prepared for publication, so keep an eye out for it in the next few months!

I have been keen to use mobile phone technology to translate the current assay, which currently requires a relatively sophisticated plate reader to record the results, into something more appropriate for use in field settings. Through the i-sense EPSRC Interdisciplinary Research Centre (IRC), my colleagues and I have been lucky enough to work with Dr Matthew Penny and Dr Steve Hilton from UCL, who have developed a working prototype of a mobile phone spectrometer that can sensitively detect the fluorescence of quantum dots (the nanoparticles I have been working with). (more…)

THET Annual Conference – Rethinking International Health Partnerships

By Hamdi Issa, PhD Candidate, Institute of Global Health Innovation

Tropical Health and Education Trust (THET)On the 20th and 21st October 2016, the Tropical Health Education Trust (THET) hosted their annual conference: ‘Evidence, Effectiveness and Impact’. This two day conference brought together academics, health care professionals, policy makers, government officials and students from all over the world, to celebrate and perhaps more importantly, learn how different health partnerships are changing the face of development.

Day one of the conference explored various elements of health partnerships, notably: the UK’s contribution to health globally and how the UK can best respond to the challenges thrown down by the Sustainable Development Goals.  Day two captured the work of individuals/groups involved in different types of health partnerships and the benefits and challenges of the different health partnership models.

THET launched their new policy paper: In our mutual interest. This policy paper captures the learning acquired by THET over the years they have managed the DfID-funded Health Partnership Scheme. By examining the associated benefits and challenges to this approach, it encourages everyone involved in health partnerships to think about how they can do more – and explore how health partnerships can be ‘mutually beneficial’ with particular considerations on the value to the NHS and UK institutions.

Aside from THET enabled health partnerships, individuals representing other forms of partnerships were present. In particular, thought-provoking presentations were delivered by two very different partnership models: FK Norway and GSK-PULSE Volunteers.

FK Norway is a Norwegian governmental body that supports exchange of employees between companies and organisations in Norway and developing countries. Through a 1 to 1 exchange ratio of participants, FK Norway aims to facilitate mutual learning and development of institutions. This method of exchange was very different from the exchanges being discussed by other partnerships. This was the first presentation to display a South to North flow of knowledge transfer as opposed to the traditional flow of knowledge (North to South). The FK Norway representative used the example of ‘kangaroo care’ as a practice widely used in developing countries to care for premature babies and through the exchange partnership, saw developing country partners teach their Norwegian partners how to train mothers in ‘kangaroo care’, at time where this practice was not widely accepted in Norway. It seems like Norway has found a partnership model that is using reciprocity to have ‘institutional-level’ impacts.

In a room full of public sector professionals, representatives from GlaxoSmithKline (GSK) brought a new perspective to the health partnership paradigm. GSK run a skills based volunteering partnership called PULSE. Through this partnership, GSK employees are matched to non-profit organisation, both at home and abroad, to tackle healthcare challenges. In light of the UKs push towards health partnerships that speak to the concept of ‘mutual benefit’ – GSK’s presentation captured a partnership model where volunteer experiences go beyond personal and professional development, to having business impact. One of the three aims of the PULSE programme is ‘change GSK’. GSK volunteers are encouraged to blog about their experiences and the learning they develop abroad, and upon return to the UK volunteers have the chance to share ideas with colleagues and senior staff to activate change within GSK.

Both GSK and FK Norway partnership models offer a learning opportunity for those involved within UK public sector health partnerships. An opportunity I hope many take advantage of if we are truly ready to move towards a new era of health partnerships, partnerships that welcome a global flow of learning and innovation to benefit health service delivery in the UK.

 

Director for the BDAU interviews the founder of the Open Data Science Conference in London

By Joshua Symons, Policy Fellow, Big Data & Analytical Unit, Centre for Health Policy  

open-data-confOn the 8th and 9th October, I had the opportunity to attend the Open Data Science Conference in London. In addition to the United Kingdom, the ODSC also occurs on both the East and West Coast of the US, as well as Tokyo. The 2-day conference had an array of speakers presenting problems and solutions they have worked on as data scientists. It was an opportunity to meet some of the leaders in the field of data science such as Gael Varoquaux. Gael is a core contributor to the popular Python machine learning resource scikit-learn and he spoke about the new and existing features of this package which help ensure rapid development in data science.

Aside from the technical speakers there were also interesting talks about how to turn ideas into reality. One such talk was given by Michael Margolis, the CEO of Get Storied, a company which specializes in helping company leaders and corporate teams in presenting their stories to deliver maximum impact. His keynote quote by Ben Horowitz stuck with me, “A company without a story is usually a company without a strategy”. Michael directly works with Google, Facebook and other industry leaders in presenting their visions as stories that involve the audience and draw them into those visions.

One of the other talks that really captured my attention was by Ian Osvald who co-authored High Performance Python. Ian spoke about how his wife and he set out on the quest to identify the source of her frequent sneezing. Together they wrote an IOS app to help collect and analyse the data surrounding her sneezing (up to 26 times a day). They used this data to inform themselves about whether or not the medications that she was prescribed were actually helping to alleviate the symptoms. This journey for answers, from identifying the problem to finding a solution, seemed to me to embody the ethos of a data scientist.

I also had the opportunity to sit with Sheamus McGovern, who is the chair and founder of the ODSC, and ask him a few questions. Sheamus and I share a similar background in finance and so I was very keen to find out what brought him to start this conference. Below is a transcript of our discussion.  (more…)

Life after miscarriage – one year on

By guest blogger, Alex, from That Butterfly Effect to mark Pregnancy and Infant Loss Remembrance Day on Saturday 15th October 

The 6th October marked a rather sad day for me and for my little family. On this day in 2015, I was admitted to hospital for a procedure called ERPC which stands for Evacuation of Retained Products of Conception and means a surgical removal of the remains of a pregnancy. It was a day that I had never thought I would ever have to experience and yet it happened to us. Just as it happens to more than one in five pregnancies in the UK every year – around a quarter of a million each year…

This second pregnancy started off wonderfully well, just as the first one. A bit of nausea, very sore breasts and some fatigue experienced during the day but overall, I felt really great. This carried on for a few weeks and then, suddenly, all the symptoms stopped, around week six or seven. I found the sudden disappearance of the soreness of breasts particularly worrying – I just had this feeling in my gut that this was way too early for them to stop hurting. And so what I did next was what we’re always told not to do – I googled the symptoms. There were quite a few forums with similar topic threads and the women discussed that dreaded M-word. Miscarriage.

Missed miscarriage (when the baby stops growing inside you but isn’t expelled from your body) was mentioned there and some things just clicked in my head. “This is exactly what has happened to me.” So I confided in my husband. He was concerned about me worrying and looked into miscarriage, but from a more pragmatic point of view, looking into ‘scientific’ evidence behind a sudden loss of pregnancy symptoms. There was nothing there to suggest a miscarriage could be easily ‘diagnosed’ simply by the loss of symptoms – there are just too many factors caused by hormonal changes happening in all stages of pregnancy. In my heart though, I just knew something was not ‘right’. The rational and optimistic part of me wanted to listen to my husband and the midwife who at the booking appointment told me not to worry as “everything will be fine”. Luckily, our dating scan was booked at 10 weeks rather than at 12 weeks so I couldn’t wait to have my mind put at rest. Going to friends’ wedding two days before the scan was not a pleasant experience – worrying about the worst case scenario whilst trying to put on a happy face and avoiding friends’ offers for a drink was so hard. They just knew I was pregnant and everyone started congratulating us. What do you say to that other than ‘thank you’? I felt emotionally drained from the past few weeks’ rollercoaster of thoughts and emotions – stuck between two sides of me, one telling me “you’re over-analysing it, just calm the f* down” and the other one crying hysterically “why do bad things always happen to good people?” before actually being told the worst. The days leading up to the scan couldn’t have dragged on for longer. (more…)

The impact of Neglected Tropical Diseases on Universal Eye Health

By Professor Alan Fenwick of Imperial’s Schistosomiasis Control Initiative (SCI)

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‘Oncho blind’ – 60 years ago blind older people were led by children

There are five neglected tropical diseases (NTDs) which are the scourge of Africa, the Indian sub-continent, the Far East and South America.  Onchocerciasis is one of these 5 and until the late 20th century caused millions of people to gradually lose their sight and eventually go blind. The parasite is spread by infected Simulium blackflies which when they bite a human, transfer microscopic larvae to the human host, where they develop into adult worms and females produce millions of new larvae during their lifetime. It is these larvae that are the cause of irreversible blindness in as many as 25% of the adult population in several countries in Africa. Onchocerciases was also prevalent in some countries in South America.

Another cause of blindness in the poorest populations globally is the NTD trachoma. Caused by certain subtypes of the Chlamydia infection, it is spread through contact with discharge from the eyes or nose of an infected person. In developing countries, eye-seeking flies are a major cause of transmission, particularly in areas where water to wash is in short supply.

trachoma flies
‘Trachoma flies’ – After conjunctivitis eyelashes scratch the cornea causing blindness.

The remaining three major NTDs, schistosomiasis, lymphatic filariasis and soil-transmitted helminths do not directly affect eye health but overlap geographically with onchocerciasis and trachoma and debilitate in other harmful ways.

All 5 of these NTDs can be controlled by the annual administration of safe oral medications. Onchocerciasis, and the resulting blindness and itching caused by the larvae are controlled by an annual dose of Mectizan (Ivermectin). Trachoma is controlled by an annual does of Zithromax, and schistosomiasis is controlled by an annual dose of praziquantel. Albendazole treats both lymphatic filariasis and soil-transmitted helminths. All four medications are generously donated by the pharmaceutical companies which manufacture them (Merck Sharp Dom, Pfizer, E.Merck and GSK respectively). In 2015 almost 1 billion individuals globally have benefitted from treatment directly resulting from these donations. (more…)

Ending the stigma this World Mental Health Day

By Dilkushi Poovendran, Research Assistant in Patient Experience and Patient Safety, Centre for Health Policy

The World Health Organisation recognises the 10th of October as World Mental Health Day.  The theme set for this year is on the delivery of psychological first aid, and the need to recognize and support individuals who are in distress.

At some point our lives, most of us will know someone experiencing a mental health issue or experience one ourselves, including stress, anxiety, depression, bereavement, or drug and alcohol problems. Yet the subject of mental illness continues to be taboo, and the stigma attached to it prevents many from speaking out and getting the attention that they need.  Worse is when someone finds the courage to seek help or advice, but are actually unable to access the treatment that they require. As the NHS copes with national cuts to mental health budgets, patients with severe and enduring mental health issues are unable to find inpatient beds or are left on long waiting lists to receive psychological services. Staffing levels within mental health services are also being stretched to their capacity, leading to unprecedented amounts of burnout amongst clinicians and support staff who are needed to care for some of the most vulnerable patients.   (more…)

World First: UN Decide to Fight Antimicrobial Resistance

By guest bloggers Sarah Greaves, Katherine MacInnes and Alex Stockham, IN-PART

For the first time in history, antimicrobial resistance was addressed recently by the United Nations (UN). In New York at the 71st General Assembly of the UN, all 193 member states signed up to combat this ever growing problem.

To fight what is said to be one of the biggest threats to 21st Century society, world leaders committed to a global, coordinated and multi-sector plan of action to not only increase the regulation of antimicrobial drug use but also to increase awareness of antimicrobial resistance and promote the development of alternative antimicrobial drugs.

This is only the fourth time in the history of the United Nations that a public health issue has been raised at a General Assembly. Previous meetings have covered HIV, non-communicable diseases (e.g. cardiovascular disease and cancer), and most recently Ebola.

Antimicrobial resistance (AMR) – where bacteria, viruses and parasites have rapidly evolved to survive exposure to antimicrobial agents – each year claims 700,000 lives. If no action is taken, by 2050 it is estimated that this number will rise to 10 million each year.

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‘Fungi Island’: The ease at which fungi proliferate is astonishing (Source: University of Michigan SNRE – CCBY2.0)

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Learning from Chinese health reforms

By Alexander Carter, Health Economist, Centre for Health Policy, IGHI

alex-article-photo-2Earlier this month I was fortunate enough to be invited to the ‘2016 Summit on China Hospital Development’, which also provided an opportunity to visit and learn first-hand about the health reforms there. My destination was Hangzhou – considered China’s most beautiful city – which is also where the recent G20 summit was held. Indeed, it is an enchanting place that seems to draw its energy from the Western lake and the surrounding mountains that cocoon the 9 million strong population in a relatively serene, yet commercially vibrant environment – exemplified by Alibaba, the e-commerce giant, which is based there.  This backdrop emphasises the contrast between China’s Maoist origins and its modern society, which has radically changed in recent decades due to the relaxation of anti-protectionist policies and expansion of internationalism.

alex-article-photo-1Post-Mao China has a number of developmental milestones to be proud of. It took the country half the time to double life expectancy compared to Western nations, and GDP has grown by 3.9 percent on average since the year 2000. Much effort and resource has been directed at health reform, with the most recent round of reforms beginning in 2008. These aim to deal with emerging population health issues. 85 percent of all deaths are now due to non-communicable diseases and this growing trend explains in part why health expenditure is expected to swell from 5.6 to 9.1 percent of GDP by 2035. In response, policy makers are taking concerted action to ensure that population health is protected in future. The infrastructure development is something to behold, expenditure on latest technologies for inpatient care delivery is staggering. With robotic prescribing of medications, telemedicine systems that link Chinese clinicians with the most esteemed Western institutions, and the birth of 7,000 bed hospitals, the country has made exhaustive provision for a population that grows by 7 million people each year. However, 60 percent of the growth in health expenditure is expected to come from hospital services and the slowing pace of economic growth is forcing China’s policy makers to reflect on how to deliver care more efficiently and to a higher quality. As part of the ‘Healthy China 2020’ vision, healthcare delivery in the country now needs to shift from hospital focussed inpatient care to community and primary care-led delivery. Integrated care models and concomitant provider payment reforms are considered a promising way forward, which was the focus of my presentation. (more…)

A letter to…my buddy Sami*, who killed himself a year ago

The letter you always wanted to write…..

Anon

The day you killed yourself was a Wednesday and when my husband called to tell me I was at work.  I felt dizzy in the sunny and overheated hallway in the hospital where I work.  I sat down and cried right there, in the hallway on a radiator.  And I didn’t care that doctors, patients and colleagues were walking past me, looking away, probably feeling bad for me, but feeling uncomfortable and not knowing how to help.

It couldn’t possibly have been you, I thought as I sat there.  You were so funny, so bubbly, so warm.  Your children, your wife, a thousand people whose hearts you’ve warmed; you have left such immense wreckage in your wake.  I know a bit about that wreckage.  Mine is not the same as yours, but when my father killed himself, he left a mess behind to clean up too.

You were 1 of the most daunting statistics: 1 of the 4,630 British men under 50 who killed themselves over the year[1].  In health policy we call suicides preventable deaths.

I could categorise you as having had “treatment resistant depression,” but as a friend looking back trying to make sense of it, I think maybe you were a man without hope in the face of what you saw were unacceptable difficulties and failures.  Where you felt personal shortcomings, your loved ones only saw external forces piling pressure on you.  If only you could have seen how so many of these difficulties were beyond your control – events you could not have avoided, no matter what. (more…)

FEAST – five years on

By Professor Kathryn Maitland, Director of the IGHI Centre of African Research and Engagement. 

First published by the Hippocratic Post on 22/8/16.

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Professor Kathryn Maitland

‘Back in 2011, my research team published the results of the largest trial of critically ill children ever undertaken in Africa (FEAST trial), a trial that examined fluid resuscitation strategies in children with severe febrile illnesses (including malaria and bacterial sepsis). Contrary to expectation, the trial showed that fluid boluses were associated with an increased mortality compared to no-bolus (control), the greatest effect was in children with the most severe forms of shock. We were delighted when the FEAST trial won the prestigious 2011 BMJ Research Paper of the Year award and expected that doctors around the world would sit up and take notice – and guidelines for management of children suffering from shock due to sepsis would change.

However, five years on, I have to say that I am disappointed that the WHO guidelines in resource-poor settings are still largely unaltered. Although the humanitarian aid charity Medicins sans Frontieres changed its own procedures within nine months of our results becoming public, the directing and coordinating agency for international health of the United Nations has so far left existing guidelines in place. This is despite the fact that we found that the intervention of rapidly administering fluids was actually harmful to children in our study which was robust and based on sound scientific evidence. One statistician said it was the most consistent he had ever seen. (more…)